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

• 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 (MWI) and Cost of Living Adjustment (COLA) (June 12, 2024) | Rate Approval Memo (September 18, 2024)


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


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


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


• 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)

Medicaid Billing Guidance

• 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 (April 28, 2021)


• Behavioral Health Billing Resource Guide (November 2023)


• 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 (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