NYS Medicaid: reduce denials MAT/ OASAS services-

If you are an OASAS provider in NY and provide services t9 NYS Medicaid 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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