North Carolina Medicaid (DHHS)

MedicaidNC

ABA billing requirements · Source: North Carolina DHHS Medicaid — ABA Services Coverage

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity6 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 componentsBehavioral, Adaptive or Functional assessment, individualized treatment plan, measurable goals, specific, behaviorally defined, measurable objectives, frequency of progress evaluation, individual providers responsible for delivering services, intervention plans utilizing research-based practices, outcome measurement assessment criteria

Progress summary cadenceEvery 6 months

Policy Notes

Policy covers beneficiaries under 21 years of age with ASD. Provisional diagnosis accepted for individuals under three years of age, with a full ASD diagnosis required within six months. Treatment plans must be reviewed no less than once every six months and rewritten annually.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for North Carolina Medicaid (DHHS).

Official policy source:North Carolina DHHS Medicaid — ABA Services Coverage

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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