Posted in In The Know Series, Insurance, Payers and CPT reinbursement, Training

Empire Plan (NYSHIP) co-pay changes for 2019-

Update: Empire Plan published updated copay list for 2020, please look at my latest post about the info.

“Empire Plan NYSHIP- Office visit co-pay changes for 2020”

Do you see NY Empire State Plan patients? Have you noticed something different in your payments for the year 2019?

If not, then do not fret. Here is what is new for the year 2019

In 2019- reimbursement for CPT code 94200 is $0 with a patient responsibility of a  co-pay of $25.

Yes, now the patient has to pay for the whole “allowed amount”!

Also the co-pay for the E/M codes also went up to $25 for certain plans. You will need to look up the benefits before the appointment.

Compare to 2018- reimbursement for CPT code 94200 was $5 with a co-pay of $20.



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s