Skip to content

Research Based Behavioral Health Treatment (RB-BHT) Clinical Coverage Policy 8F Update

August 6, 2026

Partners Health Management is notifying providers of important updates related to Clinical Coverage Policy (CCP) 8F Research Based Behavioral Health Treatment (RB-BHT). NC Medicaid recently published an updated version of CCP 8F, effective Aug. 1, 2026. NC Medicaid published a bulletin on Aug. 5, 2026, highlighting changes to the policy: Updated Reminder: Requirements for Research-Based Behavioral Health Treatment Service Delivery.

What’s Happening

Key Utilization Management and Benefit changes are highlighted below. This list is not exhaustive of all changes. Providers are responsible for reviewing the revised CCP 8F in its entirety and ensuring service delivery is in accordance.

  • Provider Standards:
    • All Licensed Qualified Autism Service Providers (LQASPs) and Certified Qualified Professionals (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 (S.L. 2026-1, 3C.18.(c)). This requirement is effective  Aug. 2, 2026.
  • Diagnosis/Assessment:
    • The policy outlines which scientifically validated tools can be used for diagnosis. Please refer to CCP 8F for additional details.
    • Adaptive functioning must be measured at least every three years using one of the tools outlined in CCP 8F.
    • Members currently receiving services: If the existing diagnosis was not established using one of the scientifically validated assessment tools identified in the policy, UM will recommend updated diagnostic testing. The updated evaluation should be completed and submitted with the member’s next authorization review.
    • New episodes of care or provider changes: Documentation supporting the diagnosis must be submitted and must meet the diagnostic requirements outlined in CCP 8F.
  • Treatment Planning and Documentation:
    • Treatment intensity must be individualized, clinically appropriate, and coordinated with all other services the beneficiary receives, including school services, therapies, respite, and other supports.
    • For treatment plans requesting more than 16 hours of service (across all codes) per week should include a schedule of all services the member is receiving. Section 5.3.3.5 includes additional required elements.
    • Staffing plan (including names and titles) must be included in the treatment plan and reflect the previous and upcoming authorization periods.
    • The treatment plan must include at least two specific and measurable caregiver goals. At least one specific, measurable goal must be tied directly to how the primary caregiver(s) will support delivery of services to reduce maladaptive behaviors or build functional skills in the beneficiary.
  • Frequency of Prior Authorization:
    • Treatment plans requesting more than 16 hours of RB-BHT services per week (across all codes) must be submitted for reauthorization every 90 days. This reauthorization requirement will be applied at the member’s next authorization review.
      • Current approved authorizations will remain in effect and will not be reduced based on this change.
    • Telehealth:
      • Telehealth is no longer permitted for paraprofessional-delivered RB-BHT services billed under CPT codes 97152-97154.
      • Telehealth use for CPT 97155 is limited to no more than 50% of the total 97155 units billed per beneficiary during an 180-day period.
      • Telehealth may not be used solely for the convenience of the provider, beneficiary, or the beneficiary’s caregiver.
      • The following RB-BHT codes are discontinued and should no longer be utilized for dates of service on or after Aug. 1, 2026:
Discontinued Code Service Description
97152 GT NC RB-BHT Assessment Follow-Up (Non-Clinical) Telehealth
97152 GT RB-BHT Assessment Follow-Up (LP) Telehealth
97153 GT RB-BHT ABA Telehealth
97154 GT RB-BHT ABA Group Telehealth
  • Current authorizations will remain valid because authorizations are issued and managed under the applicable base RB-BHT service code.

Where Can Providers Find Additional Information?

Providers should review:

What Providers Need to Do

  • Review internal billing processes and discontinue use of the affected codes for dates of service on or after Aug. 1, 2026.
  • Review the new Clinical Coverage Policy effective Aug. 1, 2026. Ensure service delivery is in accordance with the policy update.
  • Verify billing staff are aware that existing authorizations remain valid under the authorized base code.
  • RB-BHT providers should register and attend the Partners Autism Services Learning Collaborative on Aug. 18, 2026 at 3:30 p.m.
  • Partners Benefit Grid will be updated to reflect changes by Sept. 1, 2026.

Who Do I Contact If I Have Questions?

Updated: