Billing Behavioral Health (BH) Services Under Medicaid Managed Care

Medicaid Managed Care Billing and Coding Guidance | Medicaid 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 Billing and Coding Guidance

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


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


• Medicaid Managed Care Behavioral Health Coding Taxonomy (April, 2024)
  Provides the required coding construct for billing the Office of Mental Health/Office of Addiction Services and Supports (OMH/OASAS) government rates services.

Medicaid Rate Updates and Requirements

• Mandated Rate Update: Mental Health Outpatient Treatment and Rehabilitative Services (MHOTRS) Quality Improvement Collaboratives (March 31, 2025)


• Ambulatory Patient Group (APG) Peer Group Base Rates – Provider Specific Updates (January 14, 2025)


• Instructions for Utilizing the DOH APG Rate Files to Identify OMH MHOTRS Facility Rate Codes and Rates (January 27, 2025)


• PROS Redesign Effective April 1, 2025 (December 30, 2024)


• PROS Redesign Implementation Delay (September 5, 2024)


• PROS 2018 – 2021 Capital Rate Update (August 30, 2024)


• PROS Redesign: Billing and Reimbursement Changes (April 16, 2024)
• Rate Approval Memo (July 16, 2024)


• April 2024 Minimum Wage Increase and Cost of Living Adjustment (COLA) (June 12, 2024)
• Rate Approval Memo (September 18, 2024)


• Mandated Rate Update: Assertive Community Treatment (ACT) Reimbursement and Billing Changes Mandated Rate Update: ACT Reimbursement and Billing Changes (May 23, 2024)
• Rate Approval Memo (September 24, 2024)


• Mandated Rate Update: MHOTRS Quality Improvement Collaboratives (May 10, 2024)
• • Rate Approval Memo (October 16, 2024)
  
  
• Mandated Rate Update: APG Rate Changes for Psychotherapy (Group and Family Group) and Peer Support Services (April 18, 2024)


• Mandated Rate Update: July 1, 2023 Rate Increase and New APG Rate Codes for School-Based Mental Health Services in 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)


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


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


• Comprehensive Psychiatric Emergency Program (CPEP) and 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 Reimbursement (April 20, 2022)


• 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 PROS and ACT (January 18, 2022)


• Medicaid Reimbursement Rates
  Approved Medicaid fee-for-service rates for all OMH programs


• OMH Government Rates Table (Updated May 17, 2022)


• Federally Qualified Health Centers Article 31 & Article 32 Payments from Medicaid Managed Care Organizations (July 10, 2020)

Medicaid Billing Guidance

• Updated Telehealth Modifier Use for OMH-Licensed/Designated Outpatient Programs Grid and Audio-Only Modifier Change (March 28, 2025)


• Integrated Outpatient Services: 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 (April 28, 2021)


• Behavioral Health Billing Resource Guide (November 2023)


• Claiming Guidance for Clinics, Opioid Treatment, PROS and ACT
  Guidance 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

• 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 Behavioral Health claim submission with respect to MAP Plans.


• MAP Coding Taxonomy for Behavioral Health Services  (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)


• Duals Billing FAQ (August 16, 2022)
  Responses to Frequently Asked Questions related to billing for enrollees who are dually enrolled in Medicaid and Medicare