MedicaidPrior AuthHigh impact
Concurrent Delivery of Child and Adolescent Day Treatment and Residential Treatment Services
NC Medicaid - NCDHHS·NC · Psychiatry, Pediatrics·Provider Bulletin
We identified it
Jul 1, 2026
Summary
NC Medicaid clarified that Child and Adolescent Day Treatment services cannot be billed concurrently with Residential Treatment Services (Level II Program Type–IV) and seven other service types, except when medically necessary under EPSDT. Providers must now submit enhanced documentation justifying medical necessity, distinct therapeutic roles, and non-duplication for any concurrent service requests to be considered for approval.
Action Required
Immediately: Behavioral health billing team must implement a compliance review process for all claims involving Child and Adolescent Day Treatment services. (1) Review encounter forms and billing software to identify any concurrent billing of Day Treatment with: Residential Treatment Services (Level II Program Type–IV), Intensive In-Home Services, Multisystemic Therapy, Individual/Group/Family Therapy, Substance Abuse Intensive Outpatient Program, Psychiatric Residential Treatment Facility (PRTF), Substance Use Residential Services, or Inpatient Hospitalization. (2) Flag all such concurrent claims submitted to NC Medicaid Direct and NC Medicaid Managed Care for review under EPSDT policy prior to submission. (3) Update encounter documentation templates to require providers to clearly document: (a) medical necessity for the service combination, (b) distinct therapeutic purpose of each service, and (c) how services avoid duplication. (4) Train clinical and billing staff on EPSDT requirements and that concurrent service requests do not guarantee approval. (5) Direct providers to submit non-routine concurrent requests to NC Medicaid Behavioral Health Policy (DHHS-Medicaid.BHPolicy@dhhs.nc.gov) with required supporting documentation. Failure to obtain proper authorization and documentation will result in claim denials.