New York ACT Billing Codes 2027: 3 Essential Changes

The New York ACT billing codes 2027 change is coming: on January 1, 2027, Assertive Community Treatment (ACT) teams in New York stop using six rate codes, and new ones take over. The New York State Office of Mental Health (OMH) announced it in an August 17, 2026 memo to Medicaid managed care plans. ACT is a team-based program, so most solo and group therapy practices do not bill it. But if you contract with, refer to, or bill for an ACT team, this affects your claims.

What changed: New York ACT billing codes 2027 in plain terms

Assertive Community Treatment (ACT) is an OMH-licensed, team-delivered service for adults and youth with serious mental health needs. It is billed through Medicaid, usually as one monthly rate code. The August 2026 memo makes three changes:

• Rate enhancements, effective July 1, 2026. Adult and Youth ACT rates go up. The amount varies by team region, population and licensed capacity, and includes the 2.7 percent Targeted Inflationary Increase (TII) in the State Fiscal Year 2026-27 budget.
• New rate codes, procedure codes and modifiers. They identify the population served, the team size and the type of service (full, partial or inpatient). New team-size categories are Adult 100, 68, 48 and 36, and Youth 68, 48, 36 and 28.
• Old rate codes end January 1, 2027. Adult and Youth ACT teams stop billing rate codes 4508, 4509, 4511, 4513, 4514 and 4515, along with their matching procedure codes and modifiers.

This is the second recoding in a short span. Youth ACT teams moved to codes 4513 to 4515 on January 1, 2025, under an earlier OMH memo. A modifier is a two-character add-on to a procedure code that tells the payer how a service was delivered, and ACT claims now depend on them.

When it takes effect

The rate enhancements are dated July 1, 2026. The memo says they will show up in plan premiums only after State and Federal approval, and that the State will send another notice when the Division of Budget approves them. The new coding applies to dates of service on or after January 1, 2027. Claims for earlier dates stay under the current codes.

As of October 28, 2026, OMH’s Medicaid Reimbursement Rates page lists the ACT regional rate file as updated on 10/15/26. The memo points providers to that page for the specific amounts.

Who it affects

The memo is addressed to Mainstream Medicaid managed care plans, Health and Recovery Plans (HARPs), HIV Special Needs Plans and Medicaid Advantage Plus plans. Each is a Medicaid managed care organization that pays ACT claims. OMH also tells ACT providers to configure their own billing systems. It does not address young adult ACT, so check that point with the plan.

Private practices that do not run an ACT team are not billing these codes. You may still see the change in referral coordination, care-team communication and payer notices. The New York billing guide covers the broader state picture.

Practical impact of New York ACT billing codes 2027

• Claims with old rate codes and a 2027 date of service may deny or reject once plans update their systems.
• Rates paid after July 1, 2026 may be adjusted later, once approvals come through. Payment adjustments may follow, rather than a clean cutover.
• The new codes depend on team size and service type, so the right code is no longer a single obvious choice. A mismatch with the team’s licensed capacity is an easy way to get a denial.
• OMH says the memo’s Appendix A crosswalk lists the new codes. We could not read that appendix in our review, so we do not list the new codes here.

What to do next about New York ACT billing codes 2027

• Read the OMH memo and pull Appendix A for your team’s population, size and service type.
• Check the OMH rate file against what your plans are paying today.
• Ask your billing software or clearinghouse and payer contacts when the new codes will be loaded, and test a claim before January 1.
• Add January 1, 2027 as a hard date in your billing calendar, and hold or re-code any 2027 service that carries an old code.

Questions to verify with the payer

• Which new rate code, procedure code and modifier combination applies to each of our team types?
• When will you load the Medicaid fee schedule changes, and will you reprocess claims paid at old rates?
• Do you offer claims testing before January 1, 2027?
• How do you treat young adult ACT claims?

OMH lists the contacts for plans and providers at the end of the memo. Check the memo for current addresses before you write.

Where MCM South works

MCM South works with psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. See who we serve and the state billing guides. This post is operational guidance for billing, not legal advice. ACT is an OMH-licensed team program, and MCM South does not bill it.

The short version: New York ACT billing codes 2027

New York ACT billing codes 2027 mean three things: higher rates dated July 1, 2026, new rate and procedure codes by team size and service type, and the end of rate codes 4508, 4509, 4511, 4513, 4514 and 4515 on January 1, 2027. Get the crosswalk, test claims early, and watch for later payment adjustments. More guides are in Resources.

Sources checked (October 28, 2026)

• OMH memo: Mandated Rate Update, ACT Reimbursement and Billing Changes (August 17, 2026)
• OMH Medicaid Reimbursement Rates page
• OMH memo: ACT Reimbursement and Billing Changes (May 23, 2024)

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