North Carolina Medicaid Behavioral Health Billing: Manuals, Codes and Payers
North Carolina Medicaid publishes behavioral health rules as clinical coverage policies, and members are in either a Standard Plan or a Tailored Plan. This page lists the policies, the plans, and the codes we could confirm. Checked against state sources on 9/30/26.
Get My Free ConsultationIn this guide
- ✓ Clinical coverage policies 8A to 8G
- ✓ Standard Plans and Tailored Plans
- ✓ Codes in Policy 8A
- ✓ Fee schedule sources
North Carolina Medicaid Billing at a glance
This page covers north carolina medicaid billing for behavioral health claims: where the state provider manuals and code lists live, and which HCPCS codes apply to psychotherapists and psychiatrists. Rules vary by state and by payer, so confirm current requirements with the state Medicaid agency before you bill.
Use this North Carolina Medicaid Billing guide as a starting point. North Carolina Medicaid Billing rules differ by plan, so check whether a claim goes to the state fee-for-service program or to a managed care plan. Keep a copy of the current North Carolina Medicaid Billing manual your practice follows, and review your North Carolina Medicaid Billing process whenever the state issues an update.
North Carolina Medicaid at a glance
State manuals and fee schedules
| Document | What it covers |
|---|---|
| NC Medicaid | The state Medicaid agency. |
| Program-specific clinical coverage policies | Includes 8A Enhanced Mental Health and Substance Abuse Services (effective 1/1/2026), 8A-1 Assertive Community Treatment, 8A-2 Facility-Based Crisis, 8A-5 Diagnostic Assessment, 8B, 8C and 8G. |
| Fee schedule index | Archive of NC Medicaid fee schedules. |
| Health plans | Standard Plans and Tailored Plans. |
Standard Plans and Tailored Plans
| Payer | Provider site |
|---|---|
| AmeriHealth Caritas North Carolina (Standard Plan) | Provider site |
| UnitedHealthcare of North Carolina (Standard Plan) | Provider site |
| Carolina Complete Health (Standard Plan) | Provider site |
| Healthy Blue of North Carolina (Standard Plan) | Provider site |
| Alliance Health (Tailored Plan) | Providers |
| Trillium Health Resources (Tailored Plan) | For providers |
| Vaya Health (Tailored Plan) | Provider site |
Partners Health Management also runs a Tailored Plan; we did not confirm its provider URL.
HCPCS codes we could confirm
Clinical Coverage Policy 8A (effective 1/1/2026) lists H2011, H2022, H2033, H2017, H2012, H0035 and S9484. Policies 8A-1, 8A-2 and 8A-5 cover assertive community treatment, facility-based crisis and diagnostic assessment. Read the policy for each code's service name, modifiers and unit before you bill. H2017 stays flagged as an unverified in-home code in our guides.
What is changing
- Policy 8A took effect 1/1/2026. NC Medicaid posted behavioral health policy updates on 1/7/2026.
- Trillium lists a provider manual effective October 2026, so check for a newer edition.
Current as of 9/30/2026. Reconfirm before you bill.
North Carolina Medicaid billing: frequently asked questions
What are NC Medicaid Tailored Plans?
Tailored Plans are managed care plans for members with significant behavioral health needs or intellectual or developmental disabilities. Alliance, Trillium, Vaya and Partners run them.
Where are NC Medicaid behavioral health rules?
In the clinical coverage policies on the NC Medicaid site, including Policy 8A for enhanced mental health and substance abuse services.
Do all NC plans use the same fee schedule?
No. Tailored Plans set their own fee schedules, and the NC Medicaid fee schedule index covers fee-for-service.
Where this information comes from
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