---
title: Partners Health Management ABA coverage (NC Tailored Plan).
url: "https://carelu.com/payers/partners-health-management"
markdown_url: "https://carelu.com/payers/partners-health-management.md"
state: NC (North Carolina)
payer: Partners Health Management (NC Tailored Plan)
kind: Medicaid managed care plan (MCO)
parent_program: North Carolina Medicaid
description: "How Partners Health Management administers NC Medicaid RB-BHT (ABA) — CCP 8F adoption, the provider-friendly ALL-codes authorization model in ProAuth, and the recoupment caveat that comes with it."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Partners Health Management ABA coverage (NC Tailored Plan).

_Payer Guide · Partners (NC) · Last updated October 2026 · 18 primary sources_

> Merged into Vaya Partners on 10/1/2026; legacy Partners issued one ALL-codes RB-BHT authorization via ProAuth.

Partners Health Management, a Tailored Plan, adopts NC's clinical coverage policies outright for medical-necessity decisions — 8F included — and runs the most provider-friendly authorization model in the state: since October 2023, RB-BHT authorizations issue as "ALL codes," meaning one authorization on the base code covers every RB-BHT service code and modifier combination, telehealth included. The flexibility is real; so is the caveat that billing outside the approved treatment plan risks recoupment.

This plan administers the **North Carolina Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [North Carolina Medicaid guide](https://carelu.com/payers/north-carolina-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — per adopted CCP 8F [8][10]
- **Prior auth for treatment**: Required — one "ALL codes" authorization on the base code covers every RB-BHT code/modifier [9]
- **Autism diagnosis required?**: Yes — ASD via a validated diagnostic tool; under-3s may start on a provisional diagnosis [10]

## At a glance

- **Plan type:** NC Tailored Plan (public LME/MCO) — merged with Vaya Health into Vaya Partners on October 1, 2026
- **Clinical rules:** CCP 8F adopted for medical-necessity decisions
- **Prior auth:** Required — single ALL-codes authorization per member
- **Portal:** Vaya Partners ProviderCONNECT (providers.vayapartners.org/portal); legacy Partners used ProAuth
- **UM contact:** UM@VayaPartners.org · (800) 893-6246 ext. 1515 (behavioral health)
- **Rates:** ≥100% of the NC Medicaid fee schedule (state floor)

## Partners Health Management is now Vaya Partners (October 1, 2026)

Partners' own website now opens with: "Vaya Health and Partners Health Management officially merged on October 1, 2026, to become Vaya Partners," and calls itself "a legacy website" where "certain forms and resources may remain available" during the transition. NCDHHS's LME/MCO directory now lists Vaya Partners Health, not Partners, alongside Alliance and Trillium. [19][20][2][5][21]

For an ABA provider the merged plan's rules now govern: "Vaya Partners network providers must submit service authorization requests (SARs) electronically through the Vaya Partners ProviderCONNECT," and the binding rulebook is the Vaya Partners Provider Operations Manual v1.0 (Oct. 1, 2026), which replaces the 2025-2026 Partners manual. UM is UM@VayaPartners.org or 1-800-893-6246, ext. 1515 (behavioral health); provider support is 1-866-990-9712. The Partners-specific practices below (the ALL-codes authorization in ProAuth) come from legacy Partners documents; Vaya Partners has not said whether it keeps them, so ask UM before relying on them. [19][20][2][5][21]

## The ALL-codes authorization model

Instead of code-by-code authorizations, Partners issues one authorization covering all RB-BHT codes and modifiers: submit via ProAuth entering the base code as the Primary Procedure Code on the Prescreen and selecting the Treatment Type from the dropdown; authorizations are then visible in both ProAuth and Alpha. Operationally this means clinical teams can flex between assessment, direct treatment, supervision, and parent training without new requests — but every billed unit must still trace to the approved treatment plan, because Partners pairs the flexibility with post-payment review and recoupment for out-of-plan billing. [9][8][10][6]

Partners also runs an Autism Services Learning Collaborative for its network ABA providers, and its Tailored Plan documentation cross-references Carolina Complete Health policies through a Centene infrastructure partnership. [9][8][10][6]

Code set: like every NC Medicaid plan, this one pays RB-BHT only under the CPT codes in CCP 8F Attachment A, 97151–97157, in 15-minute units. 97158, 0362T and 0373T are not covered, and no HCPCS H-code (H0031, H0032, H2014, H2019) is an RB-BHT code. The plan publishes no different code list. 96112 (developmental testing) is likewise not an RB-BHT code; NC Medicaid’s billing guidance lists it among procedure codes shared by physical and behavioral health. [9][8][10][6]

## Is Partners's ABA network open or closed?

Closed. Partners' provider alert of July 8, 2026 (updated July 13): under S.L. 2026-41, RB-BHT and peer support "will transition to closed network services. This means that participation in the delivery of these services will be limited to contracted providers within the approved network." [11][12]

Providers already delivering RB-BHT "should continue operating as contracted and approved." For newcomers: "Partners will evaluate new requests to provide RB-BHT and PSS on a case-by-case basis against our selection criteria, which includes a network need." Questions go to CredentialingTeam@partnersbhm.org. [11][12]

## Can an out-of-state BCBA treat a North Carolina member, including by telehealth?

North Carolina licenses the practice itself: “it shall be a violation of this Article for any individual not licensed under this Article to practice behavior analysis” (G.S. 90-746(a); a Class 2 misdemeanor under 90-746(b)), with exemptions for NC-licensed psychologists and for behavior technicians working under a licensed professional’s direction (G.S. 90-745). An analyst licensed elsewhere has two routes: a temporary license for one who “resides and practices behavior analysis in another state,” available “only if the behavior analysis services are to be delivered during a limited and defined period of service approved by the Board” (G.S. 90-740), and licensure by reciprocity for someone actively licensed in a state with comparable requirements that reciprocates with North Carolina (G.S. 90-741). Article 43 contains no telehealth exception, so plan on an NC license before treating a child located in North Carolina by video. [13][14][15][16]

For NC Medicaid the answer is now no for a new enrollee. Session Law 2026-1 added G.S. 108C-9(e): “Board Certified Behavior Analysts and Qualified Autism Services Practitioner Supervisors shall not be permitted to enroll in the North Carolina Medicaid program as out-of-state providers,” applying to enrollment applications submitted on or after the law took effect. NC Medicaid’s August 31, 2026 reminder restates it: all LQASPs and C-QPs, “including Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts, seeking to enroll in the NC Medicaid program must do so as an in-state provider,” effective August 2, 2026. [13][14][15][16]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Partners Health Management’s network has to be enrolled with NC Medicaid as well. [13][14][15][16]

## Can Partners authorize ABA retroactively?

NC Medicaid’s rule binds the plans: CCP 8F (amended 8/1/2026) requires prior approval before RB-BHT services, says services provided without prior authorization “are not considered for payment or reimbursement except in the case of retroactive Medicaid eligibility,” and lists “services provided without prior authorization by the PHP” among the services Medicaid does not cover. [10][5]

Since the October 1, 2026 merger the Vaya Partners manual governs, and it allows a retrospective request only for late eligibility: "If a member did not have Medicaid at the time the service was provided but later gains eligibility that covers the dates of service, providers may request retrospective authorization by submitting the SAR and all documentation no later than 90 days following the notification of the Medicaid eligibility determination." [10][5]

## What is Partners Health Management’s timely filing limit and claim payment turnaround?

NC Medicaid sets the floor for every Tailored Plan and LME/MCO, Partners Health Management included. Its prompt-payment fact sheet gives Tailored Plans a 365-day timely filing window from July 1, 2024. NC Medicaid Direct claims the LME/MCOs process also moved from 90 to 365 days on July 1, 2024. The window covers the original claim and any corrected claim. State-funded services must be filed within 90 calendar days. [17][4][3][5][6][1]

Within 18 calendar days of receiving a medical claim the plan must say whether it is clean or pend it for more information. It must pay or deny a clean claim within 30 days, and deny the claim if requested information has not arrived within 90 days. Late payment carries 18% annual interest. [17][4][3][5][6][1]

Since the October 1, 2026 merger, legacy Partners claims run on the Vaya Partners schedule. Weekly cutoff: “Vaya Partners adheres to the standardized LME/MCO checkwrite schedule, which is based on a 5 p.m. Tuesday cutoff. Claims received before this cutoff date will be paid the following week according to the checkwrite schedule.” In the 2026 schedule (rev. 9/30/2026), claims posted Wednesday through Tuesday go into a check run the following Monday, with payment dated that Thursday. For example, claims posted 1/28–2/3/2026 ran on 2/9 and were paid 2/12. Holiday weeks shift by a day. The manual encourages providers to bill “on a weekly or bimonthly schedule” to match it. [17][4][3][5][6][1]

EVV does not apply to RB-BHT: NC Medicaid’s billing guidance lists the services “subject to EVV for Managed Care” as Personal Care, Home Health, Innovations Waiver, TBI and 1915(i) services (§3.52). [17][4][3][5][6][1]

Taxonomy: the plan must “validate the taxonomy code submitted on the claim” against the provider’s NC Medicaid enrollment record and “price claims based on the taxonomy code submitted on the claim” (billing guidance §3.22), so bill the taxonomy you are enrolled under in NCTracks. The Vaya Partners manual: “Accurate NPI numbers and taxonomy codes are required for claims to be accepted and processed,” and they must “exactly match the information in NCTracks,” or the claim is denied or recouped. [17][4][3][5][6][1]

Referring or ordering NPI: not required on an RB-BHT claim. NC Medicaid’s OPR guidance lists the claim types that need an ordering NPI (home infusion, private duty nursing, labs, IDTF, CAP, radiology, DME, LEA) or a referring NPI (home infusion, specialized therapy, hospice, home health, PDN, dialysis, CAP, LEA), and RB-BHT is not on either list. The physician or psychologist who signs the service order must still be enrolled in NC Medicaid (42 CFR 455.410). [17][4][3][5][6][1]

## Intake gates

The questions that decide whether a family can start with Partners Health Management (NC Tailored Plan), and what they have to bring.

- **Age limit**: Follows the NC Medicaid rule: CCP 8F carries no upper age bound (the 8/1/2026 rewrite removed "under 21 years of age" from the eligibility provision), under-21 members carry the EPSDT special provision, and beneficiaries under three may start on a provisional diagnosis. [10][9]
- **Diagnosis recency**: Follows the NC Medicaid rule: no expiry on the ASD diagnosis itself, but a provisional under-3 diagnosis must become non-provisional within six months, an adaptive behavior assessment must be under 3 years old, and diagnostic documentation must be verified and on file before services start. [10][9]
- **Who may diagnose**: Follows the NC Medicaid rule: a non-provisional ASD diagnosis comes from a Licensed Psychologist, a supervised Licensed Psychological Associate, or a physician (MD or DO); a Licensed School Psychologist evaluation may be used where the required testing is included; a provisional under-3 diagnosis may also come from a trained master’s-level licensed clinician within scope. [10][9]
- **Diagnostic tools required**: Follows the NC Medicaid rule: the ASD diagnosis must use BOSA, Tele-ASD-Peds, ADOS-2, or CARS2-ST/CARS2-HF; screeners, educational determinations and informal impressions cannot start services. The packet also needs a skills assessment (VB-MAPP, ABLLS-R or ESDM Curriculum Checklist), an FBA where challenging behaviors are targeted, and an adaptive behavior assessment within 3 years (VABS-3, ABAS-3 or DP-4). [10][9]
- **Referral required?**: Follows the NC Medicaid rule: a service order signed and dated by a Licensed MD, DO or Licensed Psychologist, in place on or before the first date of service, based on a behavioral/adaptive/functional assessment and treatment plan, valid one year and re-ordered annually. 97151 and 97152 need no service order for prior approval; 97153–97157 do. [10][9]
- **Telehealth**: Follows the NC Medicaid rule (Attachment A, eff. 8/1/2026): GT telehealth is billable for 97151 with clinical justification and for 97155 up to 50% of total 97155 billing per beneficiary per 180 days; telehealth is removed entirely for 97152, 97153 and 97154; 97156 and 97157 remain telehealth eligible and are the only KX telephonic services, on a documented caregiver health or access barrier. NC Medicaid’s billing guidance binds the plan to the same edit: “Claims submitted with Modifier GT (Telehealth) for 97152 - 97154 are not reimbursable and should be denied” (v36 §3.54.1). Telehealth claims carry the provider’s usual place-of-service code (8F Attachment A), and 8F does not require the telehealth modality to be named on the authorization. [10][9][6]
- **Prior-auth decision time**: Since the October 1, 2026 merger, Vaya Partners' manual (v1.0) governs: "For standard reviews, Vaya Partners will issue a decision within seven (7) calendar days," extendable "up to fourteen (14) additional days," and requests meeting expedited criteria are reviewed "within 72 hours." Submit a SAR "at least seven (7) calendar days prior to the requested service start date" (concurrent requests seven calendar days before the current authorization ends; the prior-authorization page caps lead time at 30 days), and answer any request for more information within one business day or the SAR is returned "unable to process." The 2025-2026 Partners manual it replaces allowed 14 calendar days plus a 14-day extension. CCP 8F requires the RB-BHT reauth before the current authorization expires. [5][2][22][23][24][10]
- **Other insurance (who pays first)**: Since the October 1, 2026 merger the Vaya Partners manual (v1.0) governs: "Medicaid is the payor of last resort." Collect all first- and third-party funds before billing Vaya Partners, wait a reasonable time for the other payer, keep its RA/EOB or other proof of payment or denial, and bill only the remaining amount; such claims are due within 180 days of the other payer's remittance, and where the member also uses state-funded services, state funds pay last. Under the legacy Partners manual, Partners would "not pay for any service that could have been paid for by Medicare or other private insurance plans had the member or provider complied with the plan's requirements" — so follow the commercial plan's ABA precert rules to the letter. Neither manual says whether the plan's own prior authorization is still needed when it pays second; CCP 8F requires prior approval before rendering RB-BHT and carves out no exception for members with other insurance, so get the plan’s authorization on file unless the plan confirms in writing that it is waived. Under federal rules TRICARE pays before Medicaid and CHAMPVA pays first when the child is also Medicaid-eligible. [5][22][10][25][26]

## Delivery and billing rules

Coverage decides whether Partners Health Management (NC Tailored Plan) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the NC Medicaid rule: at least 10% of paraprofessional-delivered services must involve LQASP observation and direction, and above 200 paraprofessional hours per 180 days the LQASP-to-paraprofessional ratio must sit between 10% and 20%, documented in the treatment plan with deviations clinically justified. Incidental supervision is not billable. Neither CCP 8F nor the Vaya Partners manual (v1.0) caps how many paraprofessionals one LQASP may supervise; the limits are the per-beneficiary 10% floor and 10–20% band. [10][9]
- **Concurrent billing (97153 + 97155)**: Follows the NC Medicaid rule: 97153 or 97154 may be billed concurrently with 97155 when a paraprofessional delivers the direct service under an eligible provider’s observation, but a single rendering provider may not bill 97153/97154 and 97155 simultaneously. 97151, 97152, 97156 and 97157 allow no concurrent billing, and non-RB-BHT services may not be billed for the same clock time. Follows the NC Medicaid rule here too. ABA alongside speech, occupational or physical therapy: Policy 8F (amended 8/1/2026) §4.2.1(n) does not cover "non-RB-BHT Medicaid services billed at the same time as RB-BHT service (as reflected in the session note …). Same-day delivery is allowable." So a speech, OT or PT visit may fall on the same day as ABA, but not on the same clock time as a billed RB-BHT session — and the session note, which must record session time in and out (§5.5.1), is what shows the two did not overlap. §4.1(c) separately excludes any service that duplicates another provider's service. [10][9]
- **Daily limits / MUEs**: Two different ceilings. Per day, a claim edit: since the October 1, 2026 merger, the Vaya Partners Provider Operations Manual (v1.0, Oct. 1, 2026) says Vaya Partners "uses National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) during adjudication to validate claims," as NC Medicaid’s billing guidance requires of every health plan (§3.6.2). The public CMS Medicaid NCCI practitioner MUE table for dates of service 10/1–12/31/2026 sets these maxima per beneficiary per date of service: 97151 32 units, 97152 16, 97153 32 (8 hours), 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32. Units above the MUE on one date of service deny as a claim edit whatever the authorization allows; the authorization, not the MUE, is the real weekly limit. Per authorization period, the NC Medicaid rule (CCP 8F sets no per-day cap of its own). Legacy Partners’ own model is unusually permissive on codes: since October 2023 one authorization on the base code covers every RB-BHT code and modifier combination, telehealth included, submitted through ProAuth with the base code as Primary Procedure Code on the Prescreen. The flexibility is paired with post-payment review — every billed unit must trace to the approved treatment plan or face recoupment. [10][9][5][6][7]
- **Session-note signature**: Follows the NC Medicaid rule: the staff member who delivered the service signs the note with credentials (professional) or job title (paraprofessional), and an LQASP or C-QP is not required to countersign a note written by non-LQASP/C-QP staff. A full note is required per contact per date of service with the elements listed in 8F subsection 5.5.1, and the treatment plan is signed and dated by the LQASP and the consenting party before services begin. [10][9]
- **Place of service**: Follows the NC Medicaid rule: clinic, home, school and community settings are all payable in any combination, individually justified and documented in the treatment plan, with the goal of advancing toward natural settings. IDEA-duplicative school services are excluded, and telehealth or telephonic claims carry the provider’s usual place-of-service code. [10][9]
- **Bill as provider**: Follows the NC Medicaid rule on rendering-provider eligibility, the professional claim and the 120-day RBT/ABAT certification clock. Partners issues authorizations as "ALL codes" on the base code, so the claim’s code and modifier can flex within the approved treatment plan without a new request — but billing outside that plan is recouped. [10][9][9]

## What intake should collect for Partners Health Management (NC Tailored Plan)

- **Treatment-plan alignment:** The ALL-codes auth only protects billing that matches the approved plan — keep the plan current as services shift.
- **ASD diagnosis + validated tool:** Per adopted CCP 8F, with the MD/DO/LP service order.
- **ProAuth setup:** Base code on the Prescreen, Treatment Type from the dropdown — train the intake/billing handoff on it once.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Partners Health Management (NC Tailored Plan) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Behavioral health administrator:** none
- **ABA rides on:** behavioral health benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 32 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | Yes — GT modifier, with clinical justification in the beneficiary’s Treatment Plan (CCP 8F Attachment A, eff. 8/1/2026). Not telephonic. | GT (telehealth) |
| 97152 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 16 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | No — telehealth was removed for 97152, 97153 and 97154 by the CCP 8F rewrite effective 8/1/2026 (Attachment A: not telehealth billable, not telephonic billable). | — |
| 97153 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 32 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | No — telehealth was removed for 97152, 97153 and 97154 by the CCP 8F rewrite effective 8/1/2026 (Attachment A: not telehealth billable, not telephonic billable). | — |
| 97154 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 18 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | No — telehealth was removed for 97152, 97153 and 97154 by the CCP 8F rewrite effective 8/1/2026 (Attachment A: not telehealth billable, not telephonic billable). | — |
| 97155 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 24 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | Yes, capped — GT modifier; telehealth may be used up to a maximum of 50% of total 97155 billing per beneficiary per 180-calendar-day period, with clinical justification in the Treatment Plan for more (CCP 8F Attachment A, eff. 8/1/2026). The observing provider may observe via telehealth while the technician delivers in person. | GT (telehealth) |
| 97156 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 16 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | Yes — GT modifier for telehealth (audio-visual). Telephonic (audio-only, KX modifier) also allowed, but ONLY when the caregiver's physical/behavioral health status or an access barrier (transportation, technology) prevents in-person or telehealth participation (CCP 8F §3.1.2 and Attachment A, eff. 8/1/2026). | GT (telehealth), KX (telephonic, caregiver-barrier criteria only) |
| 97157 | Yes | Required — ONE "ALL codes" authorization on the base code (submitted via ProAuth, base code as Primary Procedure Code on the Prescreen, Treatment Type selected from the dropdown) covers every RB-BHT code and modifier combination, telehealth included. Billing must still trace to the approved treatment plan or risk recoupment on post-payment review. | 16 units per date of service — CMS Medicaid NCCI practitioner MUE (DOS 10/1–12/31/2026), a claim edit NC Medicaid and its health plans apply; units above it on one date of service deny regardless of the authorization per Per authorization period (CCP 8F §5.1/5.1.1, eff. 8/1/2026): up to 180 days at 16 hrs/week or fewer, up to 90 days above 16 hrs/week — initial and reauth alike | home (primary private residence), office/clinic, school or work, community / place of recreation or socialization, (CCP 8F Section F is narrative only — no POS numeric codes given) | Yes — GT modifier for telehealth (audio-visual). Telephonic (audio-only, KX modifier) also allowed, but ONLY when the caregiver's physical/behavioral health status or an access barrier (transportation, technology) prevents in-person or telehealth participation (CCP 8F §3.1.2 and Attachment A, eff. 8/1/2026). | GT (telehealth), KX (telephonic, caregiver-barrier criteria only) |
| 97158 | No — 97158 is not part of NC Medicaid's CCP 8F billable RB-BHT code set (97151–97157 only) | N/A | N/A per N/A | — | N/A | — |
| 0362T | No — 0362T is not part of NC Medicaid's CCP 8F billable RB-BHT code set (97151–97157 only) | N/A | N/A per N/A | — | N/A | — |
| 0373T | No — 0373T is not part of NC Medicaid's CCP 8F billable RB-BHT code set (97151–97157 only) | N/A | N/A per N/A | — | N/A | — |

Code notes:

- **97155:** Corrected 2026-10-18: the per-day ceiling is the Medicaid MUE Vaya Partners applies at adjudication (manual v1.0). The 1-hour-per-10 figure carried here before was inferred from legacy Vaya’s pass-through rule.
- **97158, 0362T, 0373T:** Confirmed absent from CCP 8F's own CPT code table (Attachment A), from Alliance's and Trillium's posted rate schedules, and from Vaya's authorization guidelines and rate schedule — checked directly, not assumed from the CPT list.

### Medicaid rates

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97158 | N/A | N/A — not part of NC’s CCP 8F billable code set | — |
| 0362T | N/A | N/A — not part of NC’s CCP 8F billable code set | — |
| 0373T | N/A | N/A — not part of NC’s CCP 8F billable code set | — |

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-877-398-4145
- **Portal:** [Partners ProviderCONNECT Portal](https://providers.partnersbhm.org/category/providerconnect/)

Questions to ask on a verification call:

- What is Partners' payer ID for 270/271 eligibility checks — confirmed NOT 68069 (Carolina Complete Health's physical-health ID) — what do you actually use?
- What are the per-code unit caps for 97151-97157 under the single ALL-codes authorization?
- Is there a copay or coinsurance for RB-BHT, and if so is it per-visit or per-day?
- Does the deductible apply to RB-BHT, and is there an out-of-pocket max?
- What STC bucket does Partners return ABA benefit detail under on a 270/271 eligibility response?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://network.carolinacompletehealth.com/content/dam/centene/carolinacompletehealth/pdfs/Partners-Carolina-Complete-Health-FAQ-General-Topics-3.7.24.pdf (accessed 2026-07-23)
- https://www.nctracks.nc.gov/content/dam/jcr:b987d9f5-d230-4c81-b78b-05780eb0bbaf/270_271%20Health%20Care%20Eligibility%20Benefit%20Inquiry%20and%20Response%20(7).pdf (accessed 2026-07-23)
- https://medicaid.ncdhhs.gov/8f-research-based-behavioral-health-treatment-rb-bht-autism-spectrum-disorder-asd/open (accessed 2026-09-01)
- https://medicaid.ncdhhs.gov/documents/files/8f-1/open (accessed 2026-07-23)
- https://resources.vayapartners.org/wp-content/uploads/Vaya_Partners_Provider_Operations_Manual_1.0_20261001.pdf (accessed 2026-10-18)
- https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-mue-edits-practitioner-services.zip (accessed 2026-10-18)
- https://medicaid.ncdhhs.gov/health-plan-billing-guide-version-36/download?attachment= (accessed 2026-10-18)
- https://providers.partnersbhm.org/authorizations-for-research-based-behavioral-health-treatment-transition-to-all-codes/ (accessed 2026-07-23)
- https://www.alliancehealthplan.org/document-library/97251 (accessed 2026-09-27)
- https://www.trilliumhealthresources.org/sites/default/files/docs/Billing-Codes-Rates/Trillium-Rate-Table-FY-26-27.pdf (accessed 2026-07-23)
- https://providers.vayahealth.com/wp-content/uploads/2025/09/Authorization_Guidelines_Medicaid_RB_BHT_ASD.pdf (accessed 2026-07-23)
- https://www.partnersbhm.org/tailoredplan/providers/manuals-forms-and-policies/clinical-coverage-policies/ (accessed 2026-07-23)
- https://providers.partnersbhm.org/provider-network-contacts/ (accessed 2026-07-23)
- https://network.carolinacompletehealth.com/content/dam/centene/carolinacompletehealth/pdfs/Partners-CCHN-TP-General-Info-session-1-6-2026_.pdf (accessed 2026-10-14)

## Common questions

### Does Partners Health Management cover ABA therapy?

Yes — as a Tailored Plan it adopts CCP 8F for RB-BHT medical-necessity decisions, with prior authorization required per the state baseline.

### What is the ALL-codes authorization?

Since October 2023, one Partners authorization on the base code covers all RB-BHT codes and modifiers — no code-by-code requests. Billing must still match the approved treatment plan or risk recoupment.

### How do I submit an RB-BHT authorization to Partners?

Partners merged into Vaya Partners on October 1, 2026, and Vaya Partners network providers must submit SARs electronically through its ProviderCONNECT portal (UM: UM@VayaPartners.org, (800) 893-6246 ext. 1515). Legacy Partners used ProAuth, with the base code as the Primary Procedure Code on the Prescreen.

### Is Partners accepting new ABA providers?

Closed. Partners limits RB-BHT to contracted providers in its approved network; current providers continue as contracted, and new requests are reviewed case by case against selection criteria that include network need. Email CredentialingTeam@partnersbhm.org.

### What happens to the authorization when switching ABA agencies on Partners?

Partners applies CCP 8F, which does not say an authorization transfers. CCP 8F treats needing "a different RB-BHT provider agency" as a transition or discharge reason, requires the Treatment Plan to be reviewed on a change in service provider, and will not pay two providers for duplicate services. Expect the new agency to submit its own request, and confirm with Partners utilization management.

### Can an out-of-state BCBA treat Partners Health Management members in North Carolina, including by telehealth?

North Carolina requires an NC license to practice behavior analysis (G.S. 90-746), with no telehealth exception; temporary and reciprocity licenses exist (G.S. 90-740, 90-741). NC Medicaid no longer enrolls BCBAs as out-of-state providers (G.S. 108C-9(e)), and plan network providers must be enrolled with the state (42 CFR 438.602(b)(1)).

### Can Partners authorize ABA retroactively?

Only for retroactive Medicaid eligibility: under the Vaya Partners manual (in force since the October 1, 2026 merger), submit the SAR and all documentation no later than 90 days after the eligibility determination notice.

### What is Partners Health Management’s timely filing limit for ABA claims?

365 days from the date of service for Tailored Plan and NC Medicaid Direct claims since July 1, 2024, corrected claims included, under NC Medicaid’s rule for LME/MCOs. State-funded services are 90 days. Clean claims must be paid or denied within 30 days.

## Primary sources

1. [NC Medicaid — Federal Regulation Guidelines for Ordering, Prescribing or Referring (OPR) Providers (modified 7/1/2026)](https://medicaid.ncdhhs.gov/providers/claims-and-billing/federal-regulation-guidelines-ordering-prescribing-or-referring-opr-providers)
2. [Vaya Partners — Prior Authorization (ProviderCENTRAL, checked 10/11/2026)](https://providers.vayapartners.org/prior-authorization/)
3. [Vaya Partners — 2026 Checkwrite Schedule (rev. 9/30/2026)](https://resources.vayapartners.org/2026-checkwrite-schedule/)
4. [Vaya Partners — Rate and Checkwrite Schedules (ProviderCENTRAL): 5 p.m. Tuesday cutoff](https://providers.vayapartners.org/rate-checkwrite-schedules/)
5. [Vaya Partners — Provider Operations Manual v1.0 (Oct. 1, 2026)](https://resources.vayapartners.org/wp-content/uploads/Vaya_Partners_Provider_Operations_Manual_1.0_20261001.pdf)
6. [NC Medicaid — Managed Care Billing Guidance to Health Plans v36 (9/4/2026)](https://medicaid.ncdhhs.gov/health-plan-billing-guide-version-36/download?attachment=)
7. [CMS — Medicaid NCCI MUE table, practitioner services (effective 10/1/2026–12/31/2026)](https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-mue-edits-practitioner-services.zip)
8. [Partners — Tailored Plan clinical coverage policies](https://www.partnersbhm.org/tailoredplan/providers/manuals-forms-and-policies/clinical-coverage-policies/)
9. [Partners — ALL-codes authorization provider alert](https://providers.partnersbhm.org/authorizations-for-research-based-behavioral-health-treatment-transition-to-all-codes/)
10. [NC Medicaid — Clinical Coverage Policy 8F](https://medicaid.ncdhhs.gov/8f-research-based-behavioral-health-treatment-rb-bht-autism-spectrum-disorder-asd/open)
11. [Partners Health Management — Provider Alert: Changes to RB-BHT and Peer Support Services (issued July 8, 2026)](https://providers.partnersbhm.org/changes-to-rb-bht-and-peer-support-services/)
12. [Session Law 2026-41 (S.B. 257, Current Operations Appropriations Act of 2026, approved 7/7/2026), §9E.22](https://www.ncleg.gov/EnactedLegislation/SessionLaws/PDF/2025-2026/SL2026-41.pdf)
13. [N.C.G.S. Chapter 90, Article 43 — behavior analyst licensure (G.S. 90-740, 90-741, 90-745, 90-746)](https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_90/Article_43.html)
14. [Session Law 2026-1 (H.B. 696), §3C.18(c) — new G.S. 108C-9(e): no out-of-state Medicaid enrollment for BCBAs/QASP supervisors](https://www.ncleg.gov/EnactedLegislation/SessionLaws/PDF/2025-2026/SL2026-1.pdf)
15. [NC Medicaid — Updated reminder: RB-BHT service delivery requirements (8/31/2026)](https://medicaid.ncdhhs.gov/blog/2026/08/31/updated-reminder-requirements-research-based-behavioral-health-treatment-service-delivery-aug-31)
16. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
17. [NC Medicaid Managed Care Provider Playbook — Prompt Payment fact sheet (Standard Plans, NC Medicaid Direct, Tailored Plans)](https://medicaid.ncdhhs.gov/provider-playbook-prompt-payment-fact-sheet/download)
18. [Vaya Partners — Provider Communication Bulletin archive](https://providers.vayapartners.org/bulletins/)
19. [Partners Health Management — legacy site merger banner (checked 10/11/2026)](https://www.partnersbhm.org/)
20. [Vaya Partners — ProviderCENTRAL home (merger notice)](https://providers.vayapartners.org/)
21. [NCDHHS — LME/MCO directory (Alliance, Trillium, Vaya Partners)](https://www.ncdhhs.gov/providers/lme-mco-directory)
22. [Partners Health Management — 2025-2026 Provider Operations Manual (rev. 20250623)](https://providers.partnersbhm.org/wp-content/uploads/partners-provider-operations-manual.pdf)
23. [Partners — Provider Communication Bulletin #172 (CMS prior-auth timeframes postponed to 7/1/2026)](https://providers.partnersbhm.org/provider-communication-bulletin-172/)
24. [42 CFR 438.210(d) — Medicaid managed care authorization decision timeframes](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
25. [TRICARE — Using Other Health Insurance (updated 10/17/2025)](https://www.tricare.mil/Plans/OHI)
26. [VA — CHAMPVA Guidebook (updated 1/1/2025), CHAMPVA as secondary payer](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.