New York Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in New York, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This New York billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
New York billing guide: how New York pays for outpatient care
New York Medicaid moved most behavioral health services into managed care: Mainstream Medicaid Managed Care plans, Health and Recovery Plans (HARPs), HIV Special Needs Plans and Medicaid Advantage Plus (MAP) plans. That means authorization and claims depend on the member's plan. Fee-for-service remains for people outside managed care.
Fully insured commercial plans must pay in-network OMH-licensed and OASAS-certified outpatient facilities at least the Medicaid rate (since 1/1/2025). Medicare Part B claims go to National Government Services (NGS), now operating as Wellpoint Federal, in Jurisdiction K.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | NYS Department of Health, with the Office of Mental Health (OMH) and OASAS for behavioral health programs | eMedNY provider enrollment |
| Medicare Part B | National Government Services (NGS), operating as Wellpoint Federal, Jurisdiction K | CMS MAC page |
| Blue Cross Blue Shield | Four licensees by region: Anthem, Excellus, Highmark (Western NY) and Highmark (Northeastern NY) | See the Blue Cross section below |
New York Medicaid: managed care plus fee-for-service
This New York billing guide starts with Medicaid, because it decides who pays and how you file.
Behavioral health is integrated into managed care. Adults with serious mental illness moved in 2015 and 2016 (adults on SSI were excluded), and many children's behavioral health services moved from 2019 to 2021. Fee-for-service remains for populations outside managed care.
No separate carve-out vendor was found. Plans manage access to OASAS and OMH State Plan services, including Assertive Community Treatment (ACT). Always confirm the member's plan and its authorization rules before the visit.
| Item | What to know |
|---|---|
| Agency | NYS Department of Health, with OMH and OASAS |
| Provider enrollment | eMedNY enrollment page for OMH outpatient programs. Per the April 2026 Medicaid Update, the NYS Medicaid Provider Services Portal handles new enrollment for all provider types, and a NY.gov Business Account is needed. |
| Claims rules | eMedNY general billing manual: claims are due within 90 days of service, later claims need a HIPAA delay reason code, corrected claims within 60 days, and a two-year absolute limit. |
| Work requirement | Medicaid work (community engagement) requirements are scheduled for 1/1/2027 for ages 19 to 64 under H.R. 1. People with a physical or mental health condition that makes it hard to work are exempt. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Mainstream Medicaid managed care plans (2024 roster: Anthem Blue Cross and Blue Shield HP, CDPHP, Excellus BlueCross BlueShield, Fidelis Care New York, HIP (EmblemHealth), Healthfirst, Highmark Western and Northeastern New York, Independent Health, MVP Health Care, MetroPlus, Molina Healthcare, UnitedHealthcare Community Plan) | Roster from the 2024 DOH eQARR report. Confirm the current plans in each county. |
| Health and Recovery Plans (HARPs) | For adults 21 and older with significant behavioral health needs. Adds enhanced care management plus Adult Behavioral Health HCBS and CORE services. |
| HIV Special Needs Plans and Medicaid Advantage Plus (MAP) plans | MAP plans received additional behavioral health services on 1/1/2023. |
Medicare Part B in New York
For Medicare, this New York billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | National Government Services (NGS), operating as Wellpoint Federal |
| Jurisdiction | Jurisdiction K: CT, ME, MA, NH, NY, RI and VT |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in New York
This part of the New York billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. New York has four Blue plans, each with its own service area. Confirm the member's county and card before you bill.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (formerly Empire BlueCross BlueShield) | Elevance Health; independent from the other three | New York City, downstate and southeastern New York | Anthem provider news |
| Excellus BlueCross BlueShield (also Univera Healthcare) | Lifetime Healthcare Companies; not Anthem | Central New York, the East region and Rochester | See our New York Blue Cross guide |
| Highmark Blue Cross Blue Shield of Western New York | Highmark Western and Northeastern New York Inc. | Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties | See our New York Blue Cross guide |
| Highmark Blue Shield of Northeastern New York | Highmark Western and Northeastern New York Inc. | Albany, Clinton, Columbia, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties | See our New York Blue Cross guide |
Other private payers and EAPs in New York
The New York billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in New York. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| EmblemHealth/HIP, Healthfirst, Fidelis Care, MVP, CDPHP, Independent Health, UnitedHealthcare, Molina and MetroPlus | These plans appear in the 2024 DOH roster of Medicaid managed care plans. Behavioral health vendor arrangements vary by plan, so confirm each plan's manual. | Official page |
New York billing guide: state law that changes billing
Use this section of the New York billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in New York. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Most New York plans must cover mental health and substance use treatment on terms similar to physical health. From 7/1/2025 (or plan renewal), state-governed plans must meet network adequacy standards, including an initial outpatient appointment within 10 business days. Since 1/1/2025, fully insured commercial plans must pay in-network OMH-licensed and OASAS-certified outpatient facilities at least the Medicaid rate (Part AA of Chapter 57 of the Laws of 2024). Self-funded plans, Medicaid, Medicare and the Essential Plan are excluded. Source
Telehealth coverage and payment parity
Per the Center for Connected Health Policy, commercial and Medicaid telehealth payment parity runs through April 1, 2028 after a lapse from April 1 to May 28, 2026. Medicaid covers live video, store-and-forward, remote patient monitoring and audio-only (modifier 93 or FQ). Source
Prompt payment and timely filing
Medicaid: 90-day general limit with HIPAA delay reason codes, 60 days to resubmit returned claims, and a two-year absolute limit. Source
Practitioner scope: therapists and prescribers
New York participates in no licensure compact and has no telehealth-specific license. E-prescribing is mandatory for practitioners, and the prescription monitoring registry must be checked before prescribing Schedule II to IV drugs. Confirm current EPCS details with the NYS Bureau of Narcotic Enforcement. Source
Not legal advice. Confirm statute details with counsel.
New York billing guide: codes and rates
This New York billing guide lists only codes and rates confirmed on official pages.
These are the New York-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| ACT rate codes 4508, 4509, 4511, 4513, 4514 and 4515 | These and their procedure codes and modifiers retire for dates of service on or after 1/1/2027. New codes distinguish Adult and Youth ACT and team size. OMH memo dated 8/17/2026. Source |
| ACT rate enhancements effective 7/1/2026 | Include a 2.7% inflationary increase. They vary by region, population and capacity. Source |
| Modifier 93 or FQ for audio-only | OMH audio-only mental health uses modifier 93 from 7/1/2025. Source |
| E/M 99202 to 99215 Medicaid fees | Increased 4/1/2026 for selected non-facility practitioner codes, benchmarked to 90% of Medicare. Source |
| OMH outpatient rates (ACT, CDT, CPEP, PROS, MHOTRS under APG, crisis) | Increased 4/1/2026 for a minimum wage increase plus a 2.7% inflationary increase. Source |
New York billing guide: what changed, newest first
Check this New York billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Medicaid work requirements begin. Old ACT rate codes retire. | Source |
| 2026-08-17 | OMH memo announces new Adult and Youth ACT billing codes and retirement of the old rate codes on 1/1/2027. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | ACT rate enhancements take effect. Paper Medicaid enrollment applications for single-practitioner groups end in July 2026. | Source |
| 2026-04-01 | OMH outpatient rate increases and Medicaid practitioner fee increases take effect. | Source |
| 2025-07-01 | Behavioral health network adequacy standards (initial outpatient appointment within 10 business days) apply, and OMH audio-only modifier 93 begins. | Source |
| 2025-01-01 | Commercial rate mandate: fully insured plans pay in-network OMH and OASAS outpatient facilities at no less than Medicaid rates. | Source |
How do I bill mental health claims in New York?
These answers come from the same sources as the rest of this New York billing guide.
Start with the member's payer type. For New York Medicaid, bill the member's managed care plan, because most behavioral health services are integrated into plan benefits. Medicare Part B goes to NGS in Jurisdiction K. Commercial members may have one of four Blue licensees, depending on the county.
Questions about billing in New York
Who pays for behavioral health under New York Medicaid?
Most behavioral health services are integrated into Medicaid managed care plans, including mainstream plans, HARPs, HIV SNPs and MAP plans. Providers bill the member's plan, so authorization and claims rules depend on the plan.
What is the Medicaid claim filing limit in New York?
eMedNY says claims are generally due within 90 days of service. Later claims need a valid HIPAA delay reason code, and claims must be payable within two years of the date of service except for agency error or a court order.
Do New York commercial insurers have to pay behavioral health clinics at Medicaid rates?
Since January 1, 2025, fully insured commercial plans must pay in-network OMH-licensed and OASAS-certified outpatient facilities no less than the Medicaid rate. Self-funded plans, Medicaid, Medicare and the Essential Plan are excluded.
When do New York Medicaid work requirements begin?
January 1, 2027, for affected adults 19 to 64. NYC DOH says existing enrollees could be affected starting with March 2027 renewals, and people with a health condition that limits work are exempt.
Does MCM South bill for practices in New York?
MCM South serves New York. Request a quote to talk through your practice.
Sources for the New York billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- OMH ACT reimbursement and billing changes, checked October 25, 2026
- OMH H.R. 1 changes, checked October 25, 2026
- OMH behavioral health managed care, checked October 25, 2026
- NY Medicaid Update, April 2026, checked October 25, 2026
- eMedNY general billing manual, checked October 25, 2026
- eMedNY enrollment for OMH outpatient programs, checked October 25, 2026
- OMH April 1, 2026 rate updates, checked October 25, 2026
- OMH commercial rate mandate FAQs, checked October 25, 2026
- DOH Medicaid managed care plan profiles (eQARR 2024), checked October 25, 2026
- NYC DOH: behavioral health insurance, checked October 25, 2026
- NYS DOH EPCS FAQs, checked October 25, 2026
- Center for Connected Health Policy: New York, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- New York insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for New York
- New York Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Connecticut insurance companies contact guide
Billing in New York? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve New York.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.