Vaya Health (NC LME-MCO)

MedicaidNC

ABA billing requirements · Source: Vaya Health LME-MCO — Provider Resources

Medium confidence

Verified 2026-03-01

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

Progress summary cadenceEvery 6 months

Policy Notes

Vaya Health is the LME-MCO for western NC (Buncombe, Henderson, and surrounding mountain counties). ABA requires prior auth. Serves rural and mountain communities. BCBA must be enrolled with Vaya. Telehealth ABA covered with same auth requirements.

CPT & Modifier Rules

CPT rules require a free account

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

Official policy source:Vaya Health LME-MCO — Provider Resources

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

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