Eastpointe (NC LME-MCO)

MedicaidNC

ABA billing requirements · Source: Eastpointe LME-MCO — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

State licensure requiredBCBA state licensure required via NC Psychology Board

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

Eastpointe is the LME-MCO serving Edgecombe, Halifax, Nash, Northampton, Pitt, and surrounding eastern NC counties. ABA prior auth required. BCBA must be enrolled with Eastpointe. NC Medicaid Tailored Plan transitioned in 2023.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Eastpointe (NC LME-MCO).

Official policy source:Eastpointe LME-MCO — Provider Resources (Behavioral Health)

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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