Issued: February 20, 2024
Effective Monday, February 19, 2024, prior authorization is no longer required for NC Medicaid Direct NC CORE IPS-SE.
The NC Core Payment Model: Effective February 19, 2024, outlines all required documentation needed for the service.
For information on NC CORE IPS-SE benefit limits, please refer to the State-funded Individual Placement & Support (IPS) for AMH/ASA Service Definition.
If you have questions about authorizations, email UM at UMQuestions@PartnersBHM.org.
Changes to Medicaid NC CORE IPS-SE benefit limit:
| Service Code | Prior Auth Required | Initial Benefit Limit | Age Group | Level of Care | Source | Documentation Required for Authorization |
| H2023 (U4) (Z1) – Engagement Phase with Informed Decision | No | No Prior Auth Required
H2023 U4 Z1 – Engagement Phase with Informed Decision:
Maximum billable unit =1, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z1 – Engagement Phase with Informed Decision:
No documentation needed |
| H2023 (U4) (Z2) – Collaboration with Career Profile | No | No Prior Auth Required
H2023 U4 Z2 – Collaboration with Career Profile: Maximum billable unit= 1, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z2– Collaboration with Career Profile:
Intake Career Profile and Service Order (may be signed by a QP). |
| H2023 (U4) (Z3) – Milestone 3 Job Development with Retention | No | No Prior Authorization Required
H2023 U4 Z3– Milestone 3 Job Development with Retention
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (U4) (Z4) – Milestone 4 Job Support and Vocational Recovery | No | No Prior Authorization Required
H2023 U4 Z4 – Milestone 4 Job Support and Vocational Recovery
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (U4) (Z5) – Milestone 5 VR Successful Closure. | No | No Prior Authorization Required
H2023 U4 Z5 – Milestone 5 VR Successful Closure.
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (U4) (Z6) – Long-term Job Retention | No | No Prior Authorization Required
H2023 U4 Z6– Long-term Job Retention:
Employment after DVR Successful Closure.
1 unit per month, multiple months, per episode of care
1 unit = 1 event
1 documented face-to-face contact with member per month. |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z6 – Long-term Job Retention:
Individual case note. |
| H2023 (U4) (Z7) – Career Advancement | No | No Prior Authorization Required
H2023 U4 Z7– Career Advancement:
Member is working towards advancement with career, internal promotion, additional duties, external job growth. Pay increase is not required.
Up to 3 units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z7 – Career Advancement: Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (U4) (Z8) – Educational Advancement | No | No Prior Authorization Required
H2023 U4 Z8 – Educational Advancement:
Member is needing supports for completing education.
Up to 3 units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z8– Educational Advancement:
Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (U4) (Z9) – Vocational Recovery & Independence | No | No Prior Authorization Required
H2023 U4 Z9 – Vocational Recovery & Independence: Member has met the goals identified in their Career Profile.
1 unit, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 U4 Z9– Vocational Recovery & Independence:
Updated Career Profile with Vocational Recovery and Independence Plan in notes. |
Changes to State-funded NC CORE IPS-SE benefit limits:
| Service Code | Prior Auth Required | Initial Benefit Limit | Age Group | Level of Care | Source | Documentation Required for Authorization |
| H2023 (Z1) – Engagement Phase with Informed Decision | No | No Prior Auth Required
H2023 Z1 – Engagement Phase with Informed Decision:
Maximum billable unit =1, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z1 – Engagement Phase with Informed Decision:
No documentation needed |
| H2023 (Z2) – Collaboration with Career Profile | No | No Prior Auth Required
H2023 Z2 – Collaboration with Career Profile: Maximum billable unit= 1, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z2– Collaboration with Career Profile:
Intake Career Profile and Service Order (may be signed by a QP). |
| H2023 (Z3) – Milestone 3 Job Development with Retention | No | No Prior Authorization Required
H2023 Z3– Milestone 3 Job Development with Retention
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (Z4) – Milestone 4 Job Support and Vocational Recovery | No | No Prior Authorization Required
H2023 Z4 – Milestone 4 Job Support and Vocational Recovery
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (Z5) – Milestone 5 VR Successful Closure. | No | No Prior Authorization Required
H2023 Z5 – Milestone 5 VR Successful Closure.
Incentive Billing Code. Bill VR directly. Multiple billable units, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | For Milestones 3, 4, & 5:
Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (Z6) – Long-term Job Retention | No | No Prior Authorization Required
H2023 Z6– Long-term Job Retention:
Employment after DVR Successful Closure.
1 unit per month, multiple months, per episode of care
1 unit = 1 event
1 documented face-to-face contact with member per month. |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z6 – Long-term Job Retention:
Individual case note. |
| H2023 (Z7) – Career Advancement | No | No Prior Authorization Required
H2023 Z7– Career Advancement:
Member is working towards advancement with career, internal promotion, additional duties, external job growth. Pay increase is not required.
Up to 3 units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z7 – Career Advancement: Updated Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (Z8) – Educational Advancement | No | No Prior Authorization Required
H2023 Z8 – Educational Advancement:
Member is needing supports for completing education.
Up to 3 units, per episode of care
1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z8– Educational Advancement:
Follow-Along Support Plan (in Career Profile or Separate Document). Follow-Along Support Plan can be signed by QP. |
| H2023 (Z9) – Vocational Recovery & Independence | No | No Prior Authorization Required
H2023 Z9 – Vocational Recovery & Independence: Member has met the goals identified in their Career Profile.
1 unit, per episode of care 1 unit = 1 event |
18+ | LOCUS: 1-4; optional ASAM: 1-2.5 |
IPS-SE | H2023 Z9– Vocational Recovery & Independence:
Updated Career Profile with Vocational Recovery and Independence Plan in notes. |