Billing Behavioral Health (BH) Services Under Medicaid Managed Care

Medicaid Managed Care BH Billing and Coding Guidance | Medicaid BH Rate Updates and Requirements | Medicaid Billing Guidance | Medicaid Provider Enrollment | Medicaid Advantage Plus (MAP) Billing Guidance |  General Medicaid/Medicare Duals Billing Guidance | 

Medicaid Managed Care BH Billing and Coding Guidance

• New York State Medicaid Managed Care Behavioral Health Billing and Coding Manual (April, 2024)


• Summary of Edits (April, 2024) - Outlines changes to the NYS Medicaid Managed Care Behavioral Health and Coding Manual


• New York State Medicaid Managed Care Behavioral Health Coding Taxonomy (April, 2024) – Provides the required coding construct for billing the OMH/OASAS government rates services.

Medicaid BH Rate Updates and Requirements

• April 2024 Minimum Wage Increase (MWI) and Cost of Living Adjustment (COLA) (June 12, 2024)


• Mandated Rate Update: ACT Reimbursement and Billing Changes (May 23, 2024)


• Mandated Rate Update: Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Quality Improvement Collaboratives (QIC) (May 10, 2024)


• Mandated Rate Update: APG Rate Changes for Psychotherapy (Group and Family Group) and Peer Support Services (April 18, 2024)


• Mandated Rate: Billing Guidance for Delivering Services in a Language Other Than English (LOE) Within MHOTRS Programs (October 5, 2023)


• Mandated Rate Update: July 1, 2023 Rate Increase and New APG Rate Codes for School-Based Mental Health Services in Mental Health Outpatient Treatment and Rehabilitative Service (MHOTRS) Programs (September 8, 2023) | Rate Approval Memo (November 22, 2023)


• January 2023 Minimum Wage Increase and April 2023 Cost of Living Adjustment (COLA) (August 3, 2023) | Rate Approval Memo (November 20, 2023)


• Partial Hospitalization (PH) and Continuing Day Treatment (CDT) Programs Rate Update (June 8, 2023)


• 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.

Medicaid Billing Guidance

• PROS Redesign: Billing and Reimbursement Changes (April 16, 2024)


• Integrated Outpatient Services (IOS): Updated Billing for Offsite and Primary Care Services for OMH Host Sites (May 12, 2023)


• 1115 Waiver Mobile Crisis Services Provided by CPEPs (May 4, 2023)


• Behavioral Health Outpatient Revenue Codes (April 2023)


• Billing for Medication Management and Opioid Use Disorders (October 17, 2019)


• Behavioral Health Billing Resource Guide (November 2023)


• 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 (Updated April 17, 2024) - 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 Medicaid/Medicare 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