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Outpatient Behavioral Health Services

DMA Clinical Policy and Programs
Phone Number (919) 855-4290
Fax (919) 715-9451

Outpatient behavioral health services include assessment, treatment, (individual medical evaluation and management, including medication management, individual and group therapy, behavioral health counseling), family therapy, and psychological testing for recipients of all ages.

For service requirements, coverage criteria and limitations, refer to Clinical Coverage Policy #8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers

Additional information about Outpatient Behavioral Health Services is available in the following publications:

• July 2006 Special Bulletin, Authorization and Utilization Review for Behavioral Health Services
• May 2005 Special Bulletin IV, Expansion of Provider Types for Outpatient Behavioral Health Services, Phase II
• January 2005 Special Bulletin I, Expansion of Provider Types for Outpatient Behavioral Health Services

Behavioral Health Services Forms

To see forms that apply to all providers, please visit our Provider Forms page.

• Certification of Need: Medicaid Inpatient Psychiatric Services Under Age 21
• Certification of Need: Psychiatric Residential Treatment Facility Service Under Age 21
• Please refer to ValueOptions NC Medicaid for the latest version of the following forms and instructions for completing the forms.
• CAP/Targeted Case Management (CTCM) Request for Authorization Form
• Criterion V Request Form
• Inpatient Treatment Report (ITR)
• Outpatient Review Form (ORF2)

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

• Index of Articles for Outpatient Behavioral Health Services
• Index of All Bulletins
• All Bulletins by Date