Updates to Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs)

Tuesday, January 12, 2021

All temporary policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.

An amended version of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs) with an effective date of Jan. 1, 2021, was posted to the NC Medicaid Specialized Therapies Clinical Coverage Policies web page. Following is a summary of updates:

New Subsection 3.1.1, Telehealth Services, was added:

3.1.1 Telehealth Services
As outlined in Attachment A and in Section 3.8, select services within this clinical coverage policy may be provided via telehealth. Services delivered via telehealth must follow the requirements and guidance set forth in Clinical Coverage Policy 1-H: Telehealth, Virtual Communications, and Remote Patient Monitoring.

In Subsection 3.8, Psychological and Counseling Services, guidance for the delivery of select psychological and counseling treatment interventions using telehealth was added:
A select set of psychological and counseling treatment interventions may be billed by LEAs when provided to student beneficiaries using a telehealth delivery method as described in Clinical Coverage Policy 1-H. Telehealth delivery may be medically necessary when a student is medically homebound, experiencing an acute crisis, during an extended school closure, or if their school is remote or underserved such that access to appropriately qualified providers is limited.

Note: CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.

In Attachment A, Claims-Related Information guidelines for billing telehealth claims were added to Section D, Modifiers and Section F, Place of Service. Additionally, in Section C, Codes, the following CPT codes were identified as telehealth eligible services:

CPT code



Psychotherapy, 30 minutes with patient


Psychotherapy, 45 minutes with patient


Psychotherapy, 60 minutes with patient


Family psychotherapy (conjoint psychotherapy) with patient present, 50 minutes


Group psychotherapy (other than of a multiple-family group)


In Attachment A, Claims-Related Information, Section C, Codes, in accordance with the AMA’s annual CPT code update, the audiology evaluation code 92585 was end-dated effective Dec. 31, 2020, and replaced with 92652 and 92653, effective Jan. 1, 2021.

In alignment with NC General Assembly Session Law 2019-240 Senate Bill 537, and the North Carolina Board of Licensed Clinical Mental Health Counselors, references to Licensed Professional Counselor (LPC) and Licensed Professional Counselor Associate (LPCA) were changed throughout policy to Licensed Clinical Mental Health Counselor (LCMHC) and Licensed Clinical Mental Health Counselor Associate (LCMHCA) respectively.


NC Medicaid Contact Center, 888-245-0179