Ambulatory Providers

Rate codes, procedure codes and service description codes for both fee for service and managed care billing in Outpatient SUD, Opioid Treatment Programs and Integrated Services settings.

Ambulatory Patient Group procedure codes and limitations for billing Medicaid fee-for-service.

Coding Crosswalk including Rate Code, Procedure Code and Modifiers for  Health and Recovery Plans (HARP) and Mainstream Behavioral Health Carve in Services

Ambulatory Patient Group Rates for all Freestanding Outpatient levels of care.

Ambulatory Patient Group Rates for all Hospital Based Outpatient levels of care.

Letter to outpatient treatment providers outlining the transition for peer services from the Enhanced Rate Code to the Standard Rate Code

Letter to Medicaid Managed Care plans regarding the transition of peer services from the Enhanced Rate Code to the Standard Rate Code.

Ambulatory Patient Group base rates for freestanding OASAS OTPs, hospital-based OTPs, and Article 28 providers.

Effective January 1, 2021, OTP providers billing services for individuals eligible for both Medicare and Medicaid should not bill Medicaid until a claim has been processed by Medicare.

New York State guidance on reimbursement for HCV-related counseling, testing, and treatment services in OTPs and other programs with appropriate medical staffing.

Updated Guidance on Bundle Billing and Billing for Dual Eligibles.

Information on billing for buprenorphine in outpatient clinic or rehabilitation settings and in opioid treatment programs (OTPs). 

Information on billing Vivitrol in certified inpatient and outpatient settings.

An OASAS and Office of Mental Health memo on billing medication management for co-occurring disorders.