Molina Health: reduce denials MAT OASAS services (NY)

If you are an OASAS provider in NY and provide services to Molina Health plan members, then the following blog post is for you!

What has changed? Effective April 1,2026 and thereafter the EM visit rate codes will be zeroed out:

1468 – OASAS – ARTICLE 32 MEDICAL VISIT
1471 – OASAS – MMTP MEDICAL VISIT
1552 – OASAS APG – ARTICLE 32 CLINIC MEDICAL
VISIT
1555 – OASAS APG – MMTP CLINIC MEDICAL VISIT
1558 – OASAS APG – HOSP ARTICLE 32 OP REHAB
MEDICAL VISIT
1570 – OASAS APG – ARTICLE 32 OP REHAB MEDICAL VISIT

Physical health E/M codes now need to be billed using applicable
CPT/HCPCS codes under the program’s primary billing rate code, rather than separate medical visit rate codes.

New modifiers:

  • HF – Medication management
    Bundle note (G0267/G0268): weekly bundled MAT, includes MAT EM
  • Other E/M services may be billed – on the same claim/DOS
  • HE- psychiatric evaluation
  • P modifiers for physical health EM codes:P1: Normal healthy patient
    P2: Patient with mild systemic disease
    P3: Patient with severe systemic disease
  • If 2 E/M codes are billed on the same DoS/claim- reimbursement is APG

Freestanding programs – Off-site proper rare codes:

1088 – Mobile methadone services
1080 – All other off-site services (MAT and
non-MAT)

After hours MAT services: OTPs and COPs

  • Dispensing after 3pm
  • Claims containing 99051 may be submitted under rate
    code 1036 (MAT only), 1039 (MAT only), 1564, 1567, or
    1088 (if off-site), as applicable.
  • Bill quantity 1 on the day the after services were performed – with documentation

MAT Medicare cross over claims:

  • Providers billing codes G0534 and G0535 need to bill Medicaid code 90882 also with modifier GY

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