Billing Rate Updates and Requirements | Billing Guidance | Contact Information

Billing Rate Updates and Requirements

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).

• 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.

The APG CPT Revenue Calculator allows users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates for services delivered by OMH-licensed MHOTRS Programs.

• APG CPT Revenue Calculator: Illustrated
• APG CPT Revenue Calculator: Blank

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

Billing Guidance

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

School-Based Mental Health (SBMH) Clinic FAQs for Commercial Billing (March 1, 2024)

Webinar: Reimbursement for Services provided by OMH-licensed School-Based Mental Health Clinics for Commercial Plans (CTAC-MCTAC login required).

This webinar covers:

• School-Based Mental Health Clinic reimbursement requirements.
• Guidance and resources, including rates and billing information.

Contact Information

• For questions regarding commercial billing for OMH licensed services, please contact: commercial-billing@omh.ny.gov
• For provider complaints regarding behavioral health services billed under commercial insurance, please go to: File a Complaint | Department of Financial Services (ny.gov)