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NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans will launch July 1, 2024. Choice period ends on May 15, 2024. Please call to select your PCP. Find PCPs available in our health plan.

Effective February 1, 2024, citizens of Harnett County are being served by Alliance Health. Access more information for health plan participants or for providers.

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Medicaid B: Outpatient Behavioral Health Therapy (OPT)

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About

Coverage Information Icon

Medicaid Direct (Medicaid B)

Diagnosis Group(s) Information Icon

Developmental Disability, Mental Health, Substance Use

Age Group(s) Information Icon

18, 18-20, Adults 18+, Ages 16-18, Ages 16+, All, Child, Child 12-17, MCD 0-55

Reference Documents

Authorization

Submission Requirements Information Icon

Adult/Child Mental Health/Substance Use

  • SAR required when over unmanaged visits
  • Provider to maintain Service Order on file

Service Definition Authorization Parameters Information Icon

Adult/Child Mental Health/Substance Use

  • 52 unmanaged sessions per state fiscal year of any combination of Individual Therapy, Family Therapy, and Group Therapy codes

Service Codes & Descriptions

  • 90834 - Psychotherapy - 45 Minutes
  • 90837 - Psychotherapy - 60 Minutes
  • Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
  • 90808 - Individual Therapy (75-80 min)
  • 90832 59 Psychotherapy 30 minutes
  • 90837 U3 HE - OPT Plus Monthly
  • 90846 - Family Therapy w/o client
  • 90846 GT - Family Therapy w/o client
  • 90847 - Family Therapy w/ client
  • 90847 GT - Family Therapy w/client
  • 90849 - Group Therapy (multi-family)
  • 90849 GT - Group Therapy (multi-family)
  • 90853 - Group Therapy
  • 90853 GT - Group Therapy
  • 90832 - Psychotherapy - 30 Minutes
  • 90832GT - Psychotherapy - 30 Minutes
  • 90834GT - Psychotherapy - 45 Minutes
  • 90837GT - Psychotherapy - 60 Minutes
  • 90839 - Psychotherapy for Crisis First 60 Minutes
  • 90839 GT - Psychotherapy for Crisis First 60 Minutes
  • 90840 - Psychotherapy for Crisis each additional 30 minutes
  • 90840 GT - Psychotherapy for Crisis each additional 30 minutes
  • 90837 22 7C - Seven Challenges Individual
  • H0036 HK 22 Case Coordination
  • 90845 - psychoanalysis

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/8c-outpatient-behavioral-health-services-provided-direct-enrolled-providers/download?attachment">Download PDF</a>