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Office of Mental Health

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

Commercial BH Billing Guidance

  1. Department of Financial Services (DFS) Insurance Circular Letter No. 9 (2023): Reimbursement for Treatment Provided by School-Based Mental Health (SBMHC) Clinics

  2. School-Based Mental Health (SBMH) Clinic FAQs for Commercial Billing (March 1, 2024)
  3. APG CPT Revenue Calculator: This tool enables users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates. Commercial carriers are required to pay the Medicaid Rate (also known as “government rate”) for OMH licensed SBMH Clinic effective January 1, 2024. The following calculators are for identifying Medicaid APG rates for SBMH Clinic services. Commercial Plans can also reference it to calculate the reimbursement for SBMH Clinic services.

  4. 1. APG CPT Revenue Calculator: Illustrated
  5. 2. APG CPT Revenue Calculator: Blank

  6. Department of Health (DOH) Ambulatory Patient Group (APG) Rates This page houses provider-specific base rates for APGs.

  7. School-Based Mental Health Clinic Program Site List (updated weekly) – A resource for Commercial Plans listing school-based mental health clinic sites with provider IDs, NPIs, rate codes, and rates.

  8. MHOTRS APG Weight Schedule (May 8, 2024) – A resource for Commercial Plans listing possible combinations of procedures, modifiers, and other elements to determine the final APG weight. The final weight can be used with the base rate identified in the APG rate file to calculate reimbursement for MHOTRS (including School-Based Mental Health Clinic services).

  9. Reimbursement for Services provided by OMH-licensed School-Based Mental Health Clinics: for Commercial Plans Webinar
    This webinar covers:
    • 1. School-Based Mental Health Clinic reimbursement requirements
    • 2. Guidance and resources, including rates and billing information for School-Based Mental Health Clinics

  10. Contact Information:
  1. 1. For questions regarding commercial billing for OMH-licensed School-Based Mental Health Clinic services, please contact:

  2. 2. For provider complaints regarding behavioral health services billed under commercial insurance, please go to: File a Complaint | Department of Financial Services (

Please contact OMH Managed Care with any questions, comments, or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.