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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Outpatient Specialized Therapies

DMA Clinical Policy and Programs
Phone Number 919-855-4260
Fax 919-733-2796

Outpatient Specialized Therapies include evaluations, re-evaluations, and/or multidisciplinary evaluations as well as therapeutic physical, occupational, speech, respiratory, and audiologic services provided by all provider types and in all settings except hospital/rehabilitation inpatient settings. 

Prior authorization (PA) is required for all treatment services.  The Carolinas Center of Medical Excellence performs the PA functions.  All authorizations must be submitted via CCME’s new prior authorization website.  The website can be accessed through the CCME home page External link or directly at http://www.medicaidprograms.org/nc/therapyservices/.

Information on the implementation of the PA requirement is available in the November 2009 Medicaid Bulletin.

For service requirements, coverage criteria, and limitations, refer to Clinical Coverage Policy #10A, Outpatient Specialized Therapies.

Additional information on outpatient specialized therapies is available in the April 27, 2010, Video Conference Presentation (PDF, 609 KB).

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.

For information specific to the provision of service and the service setting, refer to: