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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>