North Carolina Peer Support & Medicaid Guide

North Carolina has a well-established peer support workforce serving people with mental health conditions, substance use disorders, and co-occurring behavioral health needs.

The state’s primary credential is the North Carolina Certified Peer Support Specialist, commonly abbreviated CPSS or NCCPSS.

The program is regulated by the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services, or DMH/DD/SUS. The UNC School of Social Work is contracted to oversee the certification program on behalf of the state.

North Carolina Medicaid also maintains a dedicated Peer Support Services benefit, making peer support a defined component of the state’s behavioral health system.

North Carolina Peer Support Quick Facts

Category	North Carolina overview
State Medicaid program	NC Medicaid
State behavioral health authority	DMH/DD/SUS
Primary peer credential	Certified Peer Support Specialist
Abbreviation	CPSS / NCCPSS
Lived experience	Required
Minimum recovery	18 months
Education	High school diploma or equivalent
Standard training pathway	20-hour Part I + 40-hour Part II
Alternative training pathway	Approved 50-hour in-person course
Additional training	20 hours
Standard pathway exam	Yes, 70% passing score
Certification period	2 years
Recertification training	20 hours
Ethics/boundaries CE	3 hours within renewal requirements
Medicaid peer support	Yes
Individual code	H0038
Group code	H0038 HQ
Billing unit	15 minutes
Specialized designations	Yes
Last reviewed	August 2026

What Is Peer Support in North Carolina?

North Carolina Certified Peer Support Specialists are trained individuals whose personal lived experience allows them to support others with mental health and substance use recovery.

The state describes CPSS professionals as people who can:

Meet people where they are without judgment
Help people navigate treatment systems
Support employment and housing goals
Support relationships and community connection
Teach self-advocacy
Help people engage with their treatment plans

Peer support may include:

Recovery mentoring
Goal setting
Recovery planning
Self-advocacy
System navigation
Resource connection
Treatment engagement
Community integration
Wellness support
Recovery capital development
Housing navigation
Employment support
Group peer support
Crisis recovery support
Substance use recovery support
Mental health recovery support

Peer support remains distinct from psychotherapy, diagnosis, medication management, and other clinical services requiring professional licensure.

Certified Peer Support Specialist

The Certified Peer Support Specialist is North Carolina’s primary professional peer credential.

North Carolina’s certification program recognizes people living in recovery from mental illness and/or substance use disorders who use their experience to support others who may benefit from it.

The credential is used across the state’s public behavioral health system and can qualify workers to deliver Medicaid Peer Support Services when additional Medicaid requirements are satisfied.

CPSS Eligibility Requirements

Current North Carolina requirements include:

At least 18 months of lived experience in recovery from a significant mental illness and/or substance use disorder
High school diploma or equivalent
Completion of an NCCPSS-approved training pathway
20 hours of additional training
Required Ethics and Peer Support Boundaries training
Two reference letters
Signed Code of Ethics and Conduct Policy

Applicants must meet the state’s lived-experience and recovery requirements before completing the certification process.

Lived Experience Requirement

North Carolina requires at least 18 months of lived experience in recovery from:

A significant mental illness
A substance use disorder
Or both

Lived experience is therefore not simply preferred professional experience. It is foundational to eligibility for the credential.

Education Requirement

Applicants must have:

A high school diploma, or
An equivalent credential

A college degree is not required.

North Carolina Standardized Training Pathway

North Carolina introduced an updated Peer Support Specialist Certification Curriculum in 2025.

The standardized pathway includes two major components.

Foundations of Peer Support Part I

20 hours

This component is:

Free
Self-paced
Online
Accessible through mobile devices

Foundations of Peer Support Part II

40 hours

This component is:

Free
In person
Hands-on
Focused on interactive activities and role-play

Applicants completing this pathway must also pass an online proctored final examination with a score of at least 70%.

Alternative 50-Hour Training Pathway

North Carolina also maintains an alternative certification pathway.

Applicants may complete an approved 50-hour in-person training course recognized by the NCCPSS Program.

Organizations and applicants should verify that a training course remains approved before enrolling.

Additional Training

In addition to the primary certification training pathway, applicants must complete 20 hours of additional approved training.

This includes applicable training in:

Ethics
Peer Support Boundaries
Other approved professional development areas

Supervision should not automatically be treated as satisfying training requirements.

How to Become a CPSS in North Carolina

Step 1: Meet the Recovery Requirement

Have at least 18 months of lived experience in recovery from significant mental illness and/or substance use disorder.

Step 2: Meet the Education Requirement

Have a high school diploma or equivalent.

Step 3: Complete Additional Training

Complete the required 20 hours of approved additional training.

Step 4: Submit Certification Materials

Applicants submit applicable materials such as:

High school diploma or equivalent
Signed Code of Ethics
Two letters of reference
Certificates documenting additional training

Step 5: Complete a Training Pathway

Complete either the standardized North Carolina curriculum or an approved alternative training pathway.

Step 6: Complete Examination Requirements

Applicants using the standardized pathway must pass the applicable examination.

Step 7: Finalize Certification

Submit required training documentation and complete the NCCPSS certification process.

CPSS Certification Period

North Carolina CPSS certification lasts two years.

The peer is responsible for maintaining and renewing certification.

Organizations employing CPSS professionals should independently track credential status and expiration.

CPSS Recertification

Current recertification requirements include:

20 hours of additional training during the two-year certification period
3 hours of Ethics and/or Peer Support Boundaries training
Two letters of recommendation

Credential renewal should be treated as an ongoing workforce compliance requirement rather than a one-time administrative task.

Reciprocity

North Carolina does not currently provide automatic reciprocity for peer certifications issued by other states.

A peer moving into North Carolina should therefore verify North Carolina certification requirements rather than assuming an existing credential transfers.

Specialized Peer Designations

North Carolina is developing and offering specialty training for Certified Peer Support Specialists.

Areas include:

Military peer support
Older adult peer support
Trauma
Justice-involved populations
Crisis support

These designations supplement the CPSS credential rather than replacing it.

Mental Health Peer Support

Mental health recovery is a major component of North Carolina’s CPSS workforce.

Peers may support people experiencing:

Serious mental illness
Mood disorders
Psychotic disorders
Trauma-related conditions
Other significant mental health challenges

Support may include:

Recovery mentoring
Wellness support
Self-advocacy
Community integration
Treatment engagement
Housing navigation
Employment support
Natural support development
Goal setting
Recovery planning

Substance Use Peer Support

North Carolina’s CPSS credential also includes people in recovery from substance use disorders.

CPSS professionals may support people experiencing:

Alcohol use disorder
Opioid use disorder
Stimulant use disorder
Other substance use disorders
Co-occurring mental health conditions

Substance use peer support may include:

Recovery coaching
Treatment navigation
Recovery planning
Mutual support connection
Recovery capital development
Community connection
Housing resources
Employment resources
Self-advocacy
Wellness
Recovery engagement

Co-Occurring Mental Health and Substance Use

North Carolina’s credential encompasses mental health and substance use recovery.

Peers can therefore play an important role for people experiencing co-occurring conditions.

They may help participants:

Navigate multiple systems
Develop integrated recovery goals
Engage with behavioral health treatment
Build community supports
Strengthen recovery capital
Identify resources
Develop self-advocacy
Maintain engagement

NC Medicaid Peer Support Services

North Carolina Medicaid maintains a dedicated clinical coverage policy for Peer Support Services, Policy 8G.

The policy establishes requirements involving:

Beneficiary eligibility
Provider qualifications
Staff qualifications
Service delivery
Documentation
Authorization
Billing
Supervision

Organizations intending to bill Medicaid should review the current version of Policy 8G before configuring services or claims.

Individual Peer Support Billing

North Carolina Medicaid uses:

H0038

for applicable individual Peer Support Services.

The billing unit is:

1 unit = 15 minutes

Organizations should verify current modifiers, authorization requirements, reimbursement rules, and managed care requirements before submitting claims.

Group Peer Support Billing

North Carolina Medicaid uses:

H0038 HQ

for applicable group Peer Support Services.

The billing unit is:

1 unit = 15 minutes

Medicaid Peer Support Codes

Service	Code	Unit
Individual Peer Support	H0038	15 minutes
Group Peer Support	H0038 HQ	15 minutes

Billing rules should always be verified against current NC Medicaid guidance and applicable managed care requirements.

CPSS in Other Behavioral Health Services

Certified Peer Support Specialists are not limited to one standalone Peer Support Services benefit.

North Carolina incorporates CPSS professionals into other behavioral health programs and service models.

Depending on the program, peers may serve as recovery support staff and help participants with:

Recovery
Self-determination
Self-advocacy
Wellness
Community living
Treatment engagement
Recovery planning
Resource navigation

Organizations should distinguish between standalone Peer Support Services and peer professionals incorporated into another behavioral health service.

Can a CPSS Independently Bill Medicaid?

Do not assume so.

CPSS certification establishes that an individual meets North Carolina’s peer workforce requirements.

Medicaid reimbursement separately depends on:

Provider enrollment
Organizational qualifications
Covered service
Participant eligibility
Service authorization
Staff qualifications
Supervision
Documentation
Billing requirements
Managed care requirements

Scope of Practice

North Carolina CPSS professionals provide recovery-oriented support grounded in lived experience.

Appropriate activities may include:

Sharing relevant lived experience
Recovery mentoring
Recovery planning
Goal setting
Self-advocacy
Treatment navigation
Housing navigation
Employment support
Relationship support
Community resource navigation
Wellness support
Community integration
Recovery capital development
Group peer support
Treatment engagement
Transition support

Activities Generally Outside Peer Scope

Unless separately qualified, licensed, and authorized, a CPSS generally should not:

Diagnose mental health disorders
Diagnose substance use disorders
Conduct psychotherapy
Provide licensed counseling
Prescribe medication
Provide medical advice
Conduct clinical assessments requiring licensure
Make involuntary treatment decisions
Independently modify clinical treatment
Represent themselves as a licensed clinician
Determine Medicaid eligibility
Provide legal advice

Peer Supervision

Peer-focused supervision may address:

Use of lived experience
Ethics
Boundaries
Self-determination
Recovery orientation
Role fidelity
Documentation
Difficult participant interactions
Community resources
Staff wellness
Burnout
Professional development

Administrative supervision may separately address:

Scheduling
Caseloads
Documentation completion
Credential status
Training
Attendance
Performance

Clinical consultation should be available when participant needs move beyond peer scope.

Documentation for North Carolina Peer Support

A peer support note may include:

Participant identifier
Date
Start time
End time
Duration
Location
Modality
CPSS name
Credential
Goal addressed
Peer activity
Relevant use of lived experience
Recovery activity
Advocacy
Resource navigation
Participant response
Progress
Follow-up
Connection to the applicable service or Person-Centered Plan
Signature or attestation

Documentation Should Be

Accurate
Timely
Person-centered
Recovery-oriented
Strengths-based
Specific
Respectful
Relevant
Connected to participant goals
Consistent with peer scope
Consistent with payer requirements when billed

Documentation Should Avoid

Unsupported diagnoses
Clinical interpretations outside peer scope
Stigmatizing language
Generic statements such as “provided peer support”
Copy-and-paste documentation
Unnecessary sensitive information
Documentation of services that did not occur
Personal opinions presented as clinical facts
Documentation designed solely to justify reimbursement

Documentation and Billing Are Not the Same Thing

A completed peer support note does not automatically establish Medicaid reimbursement.

Payment may additionally depend on:

Medicaid eligibility
Covered service
Provider enrollment
CPSS certification
Service authorization
Person-Centered Plan
Correct code
Correct modifier
Units
Service limits
Supervision
Documentation
Timely filing
Managed care requirements

Organizations should validate each component independently.

Credential Verification

North Carolina provides a credential verification system for employers.

Providers should verify that:

New applicants hold active certification
Existing employees remain certified
Credential expiration dates are monitored
Required renewal activities are completed

Credential verification becomes particularly important when Medicaid reimbursement depends on CPSS status.

Starting a Peer Support Program in North Carolina

Step 1: Define the Population

Determine whether the program serves:

People with mental health conditions
People with substance use disorders
People with co-occurring conditions
People experiencing crisis
Justice-involved populations
Veterans
Older adults
People receiving residential treatment
Other behavioral health populations

Step 2: Determine the Required Peer Qualification

Determine whether workers need:

CPSS certification
Specialty designation
Additional Medicaid training
Program-specific training
Population-specific lived experience

Step 3: Verify CPSS Credentials

Track:

Recovery eligibility
Primary training pathway
Additional training
Examination when applicable
Certification
Credential number
Effective date
Expiration date
Continuing education
Recertification

Step 4: Determine Funding

Potential funding may include:

NC Medicaid
State behavioral health funding
Federal grants
Opioid settlement funding
Local funding
Hospital contracts
Grants
Philanthropy
Other contracts

Step 5: Determine the Medicaid Service

If Medicaid reimbursement is planned, determine whether the peer works through:

Policy 8G Peer Support Services
Another behavioral health service incorporating CPSS staff
1915(i) services
Residential treatment
Another Medicaid service model

Step 6: Establish Supervision

Determine:

Peer supervisor
Administrative supervisor
Medicaid-required supervisor
Clinical consultant
Supervision frequency
Documentation expectations
Crisis escalation procedures

Step 7: Build the Service Workflow

Map:

Referral
Eligibility
Intake
Consent
Peer assignment
Person-Centered Plan
Scheduling
Service delivery
Documentation
Supervision
Follow-up
Outcomes
Billing

Step 8: Establish Role Boundaries

Develop policies addressing:

Use of lived experience
Peer vs. clinical roles
Confidentiality
Dual relationships
Transportation
Gifts
Social media
Communication outside work
Crisis escalation
Staff wellness
Role drift

Step 9: Configure Billing

For applicable Medicaid peer services, systems may need to support:

H0038
H0038 HQ
15-minute units
Participant eligibility
Authorization
Person-Centered Plan
CPSS credential
Modifiers where required
Documentation
Claim submission

Step 10: Measure Outcomes

Potential outcomes include:

Engagement
Recovery goal progress
Treatment initiation
Treatment retention
Recovery capital
Self-advocacy
Community connection
Housing stability
Employment
Wellness
Crisis utilization
Hospitalization
Participant satisfaction
Peer workforce retention
Documentation timeliness
Credential retention

Common Challenges for North Carolina Peer Programs

Certification Changes

North Carolina launched a new standardized CPSS curriculum in 2025.

Organizations should be careful when relying on older certification materials because training and examination requirements have changed.

Credential Expiration

CPSS certification lasts two years.

Organizations need systems for identifying upcoming expiration dates before they create workforce or billing problems.

No Automatic Interstate Reciprocity

North Carolina does not currently provide automatic reciprocity for peer credentials from other states.

This can affect organizations recruiting peers from neighboring states.

Medicaid vs. Non-Medicaid Peer Support

Not every meaningful peer interaction is necessarily a Medicaid encounter.

Programs may provide:

Community engagement
Outreach
Recovery events
Mutual support
Informal navigation
Warmline support

outside Medicaid-funded Peer Support Services.

Organizations should preserve low-barrier peer relationships while separately identifying reimbursable encounters.

Individual vs. Group Services

North Carolina distinguishes between individual and group peer services.

Systems should properly capture the service type, duration, participants, documentation, and corresponding billing configuration.

Role Drift

Peers may gradually become responsible for:

Generic case management
Administrative tasks
Transportation
Compliance monitoring
Clinical work

Organizations should preserve the distinct lived-experience function of peer support.

Rural Access

North Carolina includes significant rural communities where programs may encounter:

Peer workforce shortages
Transportation barriers
Long travel distances
Limited behavioral health providers
Limited access to supervision

Flexible community-based and virtual workflows can be important where permitted.

Fragmented Technology

Peer programs may use separate systems for:

Referral
Scheduling
Person-Centered Plans
Peer documentation
Credential tracking
Supervision
Participant communication
Outcomes
Medicaid billing
Grant reporting

This fragmentation can increase administrative burden and reduce direct peer-participant time.

Frequently Asked Questions

What is North Carolina’s peer credential?

The Certified Peer Support Specialist, or CPSS.

Who oversees CPSS certification?

North Carolina’s DMH/DD/SUS regulates the program, with the UNC School of Social Work contracted to oversee the NCCPSS Program on its behalf.

Is lived experience required?

Yes.

Applicants currently need at least 18 months of lived experience in recovery from significant mental illness and/or substance use disorder.

Is a high school diploma required?

Yes.

A high school diploma or equivalent is required.

How much CPSS training is required?

North Carolina currently provides two primary pathways.

The standardized pathway includes:

20 hours of Foundations Part I
40 hours of Foundations Part II
Final examination

An alternative pathway uses an approved 50-hour in-person course.

Applicants also complete 20 hours of additional approved training.

Is there a CPSS exam?

Under the current standardized training pathway, yes.

Applicants must pass an online proctored examination with a score of at least 70%.

How long does certification last?

Two years.

How much continuing education is required?

Current recertification requirements include 20 hours of additional training during the two-year period, including 3 hours of Ethics and/or Peer Support Boundaries training.

Does North Carolina have reciprocity with other states?

No automatic reciprocity is currently provided.

Does NC Medicaid cover peer support?

Yes.

NC Medicaid maintains a dedicated Peer Support Services policy.

What code is used for individual peer support?

H0038, in applicable Medicaid Peer Support Services.

What code is used for group peer support?

H0038 HQ, in applicable Medicaid Peer Support Services.

Can peers work with mental health populations?

Yes.

Can peers work with substance use populations?

Yes.

Can peers work with co-occurring populations?

Yes.

North Carolina’s CPSS credential encompasses lived experience involving significant mental illness and/or substance use disorder.

Can CPSS professionals work in crisis services?

Yes, within applicable programs and workforce structures.

Can CPSS professionals work with justice-involved populations?

Yes.

North Carolina is also developing specialty training related to justice-involved populations.

Are CPSS professionals clinicians?

No.

The CPSS credential itself does not constitute professional clinical licensure.

Official North Carolina Peer Support Resources

North Carolina Certified Peer Support Specialists

Official NCDHHS hub for North Carolina’s Certified Peer Support Specialist workforce, certification information, community resources, and statewide initiatives.