Skip to main content

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.

Provider Central Search

Use the search function below to search Provider Central

Non Medicaid: Evaluation and Management (E and M)

Left Arrow Icon Back to Services

About

Coverage Information Icon

State

Diagnosis Group(s) Information Icon

Assessment Only, Developmental Disability, Mental Health, Substance Use

Age Group(s) Information Icon

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

Reference Documents

Authorization

Submission Requirements Information Icon

  • Initial Patient 99201-99204
  • Established Patient 99211-99214
  • Service Authorization Request (SAR) after initial pass through of 10 sessions

Authorization Duration and Limits Information Icon

  • Pass through for the first 10 visits
  • 1 new patient visit and 16 established patent visits annually
  • Established patients are not eligible for a New Patient Evaluation

ASAM Level of Care Information Icon

ALL

Service Codes & Descriptions

  • Add on code for E&M
  • 99203 GT - E & M Detailed, New Patient
  • 99204 GT - E & M Moderate, New Patient
  • 99205 GT - E & M High, New Patient
  • 99202 GT - E & M Expanded, New Patient
  • 99211 - E&M Minimum, Estab Patient
  • 99211 GT - E&M Minimum, Estab Patient
  • 99212 GT - E & M Expanded, Estab Patient
  • 99213 - E & M Detailed, Estab Patient
  • 99213 GT - E & M Detailed, Estab Patient
  • 99214 - E & M Moderate, Estab Patient
  • 99214 GT - E & M Moderate, Estab Patient
  • 99215 - E & M High Estab Patient
  • 99215 GT - E & M High Estab Patient
  • 99202 - E & M Expanded, New Patient
  • 99203 - E & M Detailed, New Patient
  • 99204 - E & M Moderate, New Patient
  • 99205 - E & M High, New Patient
  • 99212 - E & M Expanded, Estab Patient

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/media/10107/open">Download PDF</a>