Issued: February 20, 2024

Effective Monday, February 19, 2024, prior authorization is no longer required for NC Medicaid Direct NC CORE IPS-SE.

The NC Core Payment Model: Effective February 19, 2024, outlines all required documentation needed for the service.

For information on NC CORE IPS-SE benefit limits, please refer to the State-funded Individual Placement & Support (IPS) for AMH/ASA Service Definition.

If you have questions about authorizations, email UM at UMQuestions@PartnersBHM.org.

Changes to Medicaid NC CORE IPS-SE benefit limit:

Service Code Prior Auth Required Initial Benefit Limit Age Group Level of Care Source Documentation Required for Authorization
H2023 (U4) (Z1) – Engagement Phase with Informed Decision No No Prior Auth Required

 

H2023 U4 Z1 – Engagement Phase with Informed Decision:

 

Maximum billable unit =1, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z1 – Engagement Phase with Informed Decision:

No documentation needed

 H2023 (U4) (Z2) – Collaboration with Career Profile No No Prior Auth Required

 

H2023 U4 Z2 – Collaboration with Career Profile:

Maximum billable unit= 1, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z2– Collaboration with Career Profile:

Intake Career Profile and Service Order (may be signed by a QP).

H2023 (U4) (Z3) – Milestone 3 Job Development with Retention No No Prior Authorization Required

 

H2023 U4 Z3– Milestone 3 Job Development with Retention

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (U4) (Z4) – Milestone 4 Job Support and Vocational Recovery No No Prior Authorization Required

 

H2023 U4 Z4 – Milestone 4 Job Support and Vocational Recovery

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (U4) (Z5) – Milestone 5 VR Successful Closure. No No Prior Authorization Required

 

H2023 U4 Z5 – Milestone 5 VR Successful Closure.

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (U4) (Z6) – Long-term Job Retention No No Prior Authorization Required

 

H2023 U4 Z6– Long-term Job Retention:

 

Employment after DVR Successful Closure.

 

1 unit per month, multiple months, per episode of care

 

1 unit = 1 event

 

1 documented face-to-face contact with member per month.

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z6 – Long-term Job Retention:

 

Individual case note.

H2023 (U4) (Z7) – Career Advancement No No Prior Authorization Required

 

H2023 U4 Z7– Career Advancement:

 

Member is working towards advancement with career, internal promotion, additional duties, external job growth. Pay increase is not required.

 

Up to 3 units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z7 – Career Advancement:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.
H2023 (U4) (Z8) – Educational Advancement No No Prior Authorization Required

 

H2023 U4 Z8 – Educational Advancement:

 

Member is needing supports for completing education.

 

Up to 3 units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z8– Educational Advancement:

 

Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (U4) (Z9) – Vocational Recovery & Independence No No Prior Authorization Required

 

H2023 U4 Z9 – Vocational Recovery & Independence:

Member has met the goals identified in their Career Profile.

 

1 unit, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 U4 Z9– Vocational Recovery & Independence:

 

Updated Career Profile with Vocational Recovery and Independence Plan in notes.

 

Changes to State-funded NC CORE IPS-SE benefit limits:

 

Service Code Prior Auth Required Initial Benefit Limit Age Group Level of Care Source Documentation Required for Authorization
H2023 (Z1) – Engagement Phase with Informed Decision No No Prior Auth Required

 

H2023 Z1 – Engagement Phase with Informed Decision:

 

Maximum billable unit =1, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z1 – Engagement Phase with Informed Decision:

No documentation needed

 H2023 (Z2) – Collaboration with Career Profile No No Prior Auth Required

 

H2023 Z2 – Collaboration with Career Profile:

Maximum billable unit= 1, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z2– Collaboration with Career Profile:

Intake Career Profile and Service Order (may be signed by a QP).

H2023 (Z3) – Milestone 3 Job Development with Retention No No Prior Authorization Required

 

H2023 Z3– Milestone 3 Job Development with Retention

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (Z4) – Milestone 4 Job Support and Vocational Recovery No No Prior Authorization Required

 

H2023 Z4 – Milestone 4 Job Support and Vocational Recovery

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (Z5) – Milestone 5 VR Successful Closure. No No Prior Authorization Required

 

H2023 Z5 – Milestone 5 VR Successful Closure.

 

Incentive Billing Code. Bill VR directly.

Multiple billable units, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE For Milestones 3, 4, & 5:

 

 

Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (Z6) – Long-term Job Retention No No Prior Authorization Required

 

H2023 Z6– Long-term Job Retention:

 

Employment after DVR Successful Closure.

 

1 unit per month, multiple months, per episode of care

 

1 unit = 1 event

 

1 documented face-to-face contact with member per month.

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z6 – Long-term Job Retention:

 

Individual case note.

H2023 (Z7) – Career Advancement No No Prior Authorization Required

 

H2023 Z7– Career Advancement:

 

Member is working towards advancement with career, internal promotion, additional duties, external job growth. Pay increase is not required.

 

Up to 3 units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z7 – Career Advancement:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.
H2023 (Z8) – Educational Advancement No No Prior Authorization Required

 

H2023 Z8 – Educational Advancement:

 

Member is needing supports for completing education.

 

Up to 3 units, per episode of care

 

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z8– Educational Advancement:

 

Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP.

H2023 (Z9) – Vocational Recovery & Independence No No Prior Authorization Required

 

H2023 Z9 – Vocational Recovery & Independence:

Member has met the goals identified in their Career Profile.

 

1 unit, per episode of care

1 unit = 1 event

18+ LOCUS: 1-4; optional
ASAM: 1-2.5
IPS-SE H2023 Z9– Vocational Recovery & Independence:

 

Updated Career Profile with Vocational Recovery and Independence Plan in notes.