Updated: April 6, 2023
Please reference the tables below for changes.
Services with no changes for Tailored Plan effective October 1, 2023, or NC Medicaid Direct effective April 1, 2023 (Nothing needed from provider – no code changes)
| Current in Lieu of Service (ILOS) Name and Code | Tailored Plan ILOS effective October 1, 2023 | NC Medicaid Direct ILOS effective April 1, 2023 |
| Assertive Community Treatment-Step Down (ACT-SD) H0040 U5 | Assertive Community Treatment- Step Down (ACT-SD) H0040 U5 | Assertive Community Treatment-Step Down (ACT-SD) H0040 U5 |
| Behavioral Health Urgent Care (BHUC)
T2016 U5 |
Behavioral Health Urgent Care (BHUC)
T2016 U5 |
Behavioral Health Urgent Care (BHUC)
T2016 U5 |
| Child Focused Assertive Community Treatment Team (Child ACTT)
H0040 HA U5 Encounter Code: H0040 HA U5 EN |
Child Focused Assertive Community Treatment Team (Child ACTT)
H0040 HA U5 Encounter Code: H0040 HA U5 EN |
Child Focused Assertive Community Treatment Team (Child ACTT)
H0040 HA U5 Encounter Code: H0040 HA U5 EN |
| Individual Rehabilitation, Coordination and Support Services
H2017 U5 (AKA Psychosocial Rehabilitation-PSR) |
Individual Rehabilitation, Coordination and Support Services
H2017 U5 (AKA Psychosocial Rehabilitation-PSR) |
Individual Rehabilitation, Coordination and Support Services
H2017 U5 (AKA Psychosocial Rehabilitation-PSR) |
| Rapid Care Services
S9480 U5: Rapid Care Services Low S9480 HK U5: Rapid Care Services High |
Rapid Care Services
S9484 U5: Rapid Care Services Low S9484 HK U5: Rapid Care Services High |
Rapid Care Services
S9484 U5: Rapid Care Services Low S9484 HK U5: Rapid Care Services High |
| Residential Services-Complex Needs H0018 | Residential Services-Complex Needs H0018 | Residential Services-Complex Needs H0018 |
| Rapid Response Bed Therapeutic Foster Care for Children and Youth
S5145 U5 |
Rapid Response Bed Therapeutic Foster Care for Children and Youth
S5145 U5 |
Rapid Response Bed Therapeutic Foster Care for Children and Youth
S5145 U5 |
Services below will transition to new service codes beginning April 1, 2023.
Nothing is needed from the provider. UM will end date active authorizations with old service codes and use the crosswalk below to prorate units and create new authorizations effective April 1, 2023.
| Current in Lieu of Service (ILOS) Name and Code | Tailored Plan ILOS effective October 1, 2023 | NC Medicaid Direct ILOS effective April 1, 2023 |
| Family Centered Treatment (FCT)
H2022-22-HE H2022-22-Z1 3 months outcome H2022-22-Z2 6 months outcome H2022-22-Z3 Encounter
|
Family Centered Treatment (FCT)
H2022 U5 U1 (Core) H2022 U5 U2 (3 months outcome) H2022 U5 U3 (6 months outcome) H2022 U5 U4 (Encounter) |
Family Centered Treatment (FCT)
H2022 U5 U1 (Core) H2022 U5 U2 (3 months) H2022 U5 U3 (6 months) H2022 U5 U4 (Encounter) |
| High Fidelity Wraparound (HFWA)
H0032 HF H0032 HF FW |
High Fidelity Wrap Around (HFWA)
H0032 U5 Encounter Code: H0032 U5 U1 |
High Fidelity Wrap Around (HFWA)
H0032 U5 Encounter code: H0032 U5 U1 |
| Long Term Community Supports (LTCS)
Home Living LTCS Level 1 T2016 U5 L1
Independent Living LTCS Level 2 T2016 U5 L2
Companion Living LTCS Level 3 T2016 U5 L3
Companion Living Level 3 LTCS Therapeutic Leave T2016 U5 L3 TL
Supervised Living LTCS Level 4 T2016 U5 L4
Supervised Living LTCS Level 4 Therapeutic Leave T2016 U5 L4 TL
Group Living LTCS Level 5 T2016 U5 L5
Group Living LTCS Level 5 Therapeutic Leave T2016 U5 L5 |
Long Term Community Supports (LTCS)
Home Living LTCS Level 1 T2016 U5 U1
Independent Living LTCS Level T2016 U5 U2
Companion Living LTCS Level 3 T2016 U5 U3
Companion Living Level 3 LTCS Therapeutic Leave T2016 U5 U3 TL
Supervised Living LTCS Level 4 T2016 U5 U4
Supervised Living LTCS Level 4 Therapeutic Leave T2016 U5 U4 TL
Group Living LTCS Level 5 T2016 U5 U6
Group Living LTCS Level 5 Therapeutic Leave T2016 U5 U6 TL |
Long Term Community Supports (LTCS)
Home Living LTCS Level 1 T2016 U5 U1
Independent Living LTCS Level T2016 U5 U2
Companion Living LTCS Level 3 T2016 U5 U3
Companion Living Level 3 LTCS Therapeutic Leave T2016 U5 U3 TL
Supervised Living LTCS Level 4 T2016 U5 U4
Supervised Living LTCS Level 4 Therapeutic Leave T2016 U5 U4 TL
Group Living LTCS Level 5 T2016 U5 U6
Group Living LTCS Level 5 Therapeutic Leave T2016 U5 U6 TL |
| In Home Therapy Services (IHTS)
H2022 HE U5 U1 Encounters: H2022 HE U5 TS |
In Home Therapy Services (IHTS)
H2022 HE U5 Encounters: H2022 TS U5 |
In Home Therapy Services (IHTS)
H2022 HE U5 Encounters: H2022 TS U5 |
Services below will be discontinued effective April 1, 2023. Providers will need to transition members to another appropriate service.
| Current in Lieu of Service (ILOS) Name and Code | Tailored Plan ILOS effective October 1, 2023 | NC Medicaid Direct ILOS effective April 1, 2023 |
| Case Support-State Benefit Plan
YP215 |
N/A | N/A |
| Case Support-Special Situations T1016-U5 | N/A | N/A |
| Comprehensive Clinical Support-Special Circumstances
G2021-U5 |
N/A | N/A |
| Critical Time Intervention H0032 U5 DJ | N/A | N/A |
| Dialectical Behavioral Therapy H2019 U5 | N/A | N/A |
| Outpatient Plus
90837 U5, 90837 U5 EN H0036 U5 EN |
N/A | N/A |
| SUD Comprehensive Outpatient Treatment During Disaster H2035 U5 | N/A | N/A |
| SUD Intensive Outpatient Program
H0015 U5 |
N/A | N/A |
| SUD Intensive Outpatient Program
H0015 U5 |
N/A | N/A
|
| Young Adults in Transition | N/A | N/A |
New services as of April 1, 2023 – providers need to submit a Change Request Form to add new codes.
Click here to access the Change Form. Submit completed form and all applicable attachments to credentialingteam@partnersbhm.org.
| Current In Lieu Of Service (ILOS) Name and Code | Tailored Plan ILOS effective October 1, 2023 | NC Medicaid Direct ILOS effective April 1, 2023 |
| N/A | Acute and Subacute Services Provided in an Institute for Mental Disease
0160 |
Acute and Subacute Services Provided in an Institute for Mental Disease
0160 |