Billing Behavioral Health (BH) Medicaid Services Under Managed Care
Mainstream/Health and Recovery Plan (HARP) Billing Guidance
- New York State HARP / Mainstream Behavioral Health Billing and Coding Manual (May 18, 2017)
- Mainstream/HARP Coding Taxonomy (October 16, 2020) – This file provides the required coding construct for billing the OMH/OASAS government rates services.
BH Rate Updates and Requirements
- Comprehensive Psychiatric Emergency Program (CPEP) and Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) – Peer Rate Update (January 26, 2023)
- Article 31 Clinic Enhanced Federal Medical Assistance Percentage (eFMAP) Rate Increase Notification (September 1, 2022)
- April 2022 Cost of Living Adjustment (COLA) (July 7, 2022)
- Anticipated American Rescue Plan Act (ARPA) Reimbursement (ACT, PROS, CORE, HCBS) (April 20, 2022)
- Enhanced Federal Medical Assistance Percentage (eFMAP) Rate Enhancement for Home and Community-Based Services (HCBS) and Community Oriented Recovery and Empowerment (CORE) Services (February 11, 2022)
- Enhanced Federal Medical Assistance Percentage Rate Enhancement for Personalized Recovery Oriented Services (PROS) and Assertive Community Treatment (ACT) (January 18, 2022)
- Medicaid Reimbursement Rates - Approved Medicaid fee-for-service rates for all OMH programs
- HARP BH HCBS Fee Schedule (August 8, 2022)
- CORE Fee Schedule (August 8, 2022)
- Office of Mental Health (OMH) Government Rates Table (Updated May 17, 2022)
- Federally Qualified Health Centers (FQHC) Article 31 & Article 32 Payments from Medicaid Managed Care Organizations (July 10, 2020)
- Quick Reference Guide: Protections for BH Government Rates
- Required Managed Care Organization (MCO) Payment of Ambulatory Patient Groups (APGs) and Government Rates (November 2, 2017)
Contracts for ambulatory behavioral health services that state MCOs may pay “the lessor of APGs or charges” is in violation of law for both APGs or other forms of government rates. DOH is directing MCOs to ensure reimbursement to providers for ambulatory behavioral health services is at the APG rate for behavioral health clinic services or the published government rate for other ambulatory behavioral health services.
- Integrated Outpatient Services (IOS): Updated Billing for Offsite and Primary Care Services for OMH and OASAS Host Sites (December 22, 2022)
- Crisis Follow-up Services for CPEPs (May 24, 2022)
- Behavioral Health Outpatient Revenue Codes (June 2021)
- Billing for Medication Management and Opioid Use Disorders (October 17, 2019)
- Behavioral Health Billing Resource Guide (September 9, 2019)
- Adult BH HCBS Staff Transportation Billing Guidance
- Billing Comprehensive Psychiatric Emergency Programs (CPEP) and Extended Observation Beds (EOB) (August 3, 2016) | Supplemental Guidance (April 26, 2016)
- Claiming Guidance for Clinics, Opioid Treatment (OTP), PROS and ACT for claims that utilize the OASAS or OMH unlicensed practitioner ID
Medicaid Provider Enrollment
- eMedNY Provider Enrollment – Guides, FAQs, and additional information related to the Medicaid Managed Care (MMC) network provider enrollment in New York State Medicaid
- eMedNY What’s New Archives – Information on 21st Century Cures Act and other guidance
Medicaid Advantage Plus (MAP) Billing Guidance
- New York State Medicaid Advantage Plus (MAP) Plans Behavioral Health Billing and Coding Manual (Released July 1, 2022) - This guidance outlines the claiming requirements necessary to ensure proper BH claim submission with respect to MAP Plans.
- MAP Coding Taxonomy for BH Services (Released July 1, 2022) - Provides coding crosswalk from rate codes to procedure codes and modifiers for MAP Plan Behavioral Health Carve-in Services.
General Duals Billing Guidance
- Billing for Dual Eligible Enrollees - Provides guidance on billing both Medicare and Medicaid via 0Fill process
- Duals Reimbursement in Medicaid Managed Care (Reissued December 1, 2021. Original guidance release date: May 14, 2021)
- Duals Billing FAQ (August 16, 2022) - Responses to Frequently Asked Questions related to billing for enrollees who are dually enrolled in Medicaid and Medicare
* If you are having accessibility issues with the previous documents, please contact Office of Diversity Management, or call (518) 473-4144.
All questions or complaints regarding Behavioral Health Medicaid Managed Care should be submitted to the OMH Division of Managed Care using the OMH MC Question/Complaint Form. This ensures all questions or complaints submitted can be reviewed and responded to by appropriate staff within OMH and/or the Department of Health.