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There are Federal changes to Medicaid and new laws are changing the rules for NC Medicaid. Some people with Medicaid will have to follow new rules to keep their coverage. For more information, visit Medicaid is Changing | NC Medicaid.

Effective July 1, 2026, WakeMed is no longer in Alliance’s network for Tailored Plan services. Services provided by WakeMed after this date may be treated as out-of-network. Get full details here.

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Non Medicaid: Evaluation and Management (E and M)

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About

Coverage Information Icon

Non-Medicaid (State)

Diagnosis Group(s) Information Icon

Mental Health, Substance Use, Developmental Disability, Assessment Only

Age Group(s) Information Icon

Adults 18+, Child

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 patient visits annually
  • Established patients are not eligible for a New Patient Evaluation

ASAM Level of Care Information Icon

ALL

Service Codes & Descriptions

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

Full Service Definition

<a target="_blank" href="https://www.ncdhhs.gov/state-funded-outpatient-behavioral-health-services-6-1-23/download?attachment">Download PDF</a>