Behavioral Health Billing Services in New York
Last reviewed October 6, 2026 by the Healthcare Logic revenue cycle team.
New York pays for behavioral health through Medicaid managed care plans, but the state sets the floor. Plans must pay OMH-licensed and OASAS-certified programs at least the Medicaid fee-for-service government rate, calculated through Ambulatory Patient Groups (APGs). If the rate code, coding taxonomy or APG grouping is wrong, the claim either denies or quietly underpays.
Healthcare Logic supports New York clinics, group practices, psychiatry groups, OASAS programs and FQHCs with coding to the state billing manual, HARP and mainstream plan billing, underpayment review and credentialing.
New York behavioral health billing at a glance
| Medicaid program | New York State Medicaid; fee-for-service claims through eMedNY |
|---|---|
| Behavioral health delivery | Carved into Medicaid managed care since October 2015 (NYC) and July 2016 (rest of state) |
| Specialty plans | Health and Recovery Plans (HARPs) for adults with serious mental illness or substance use disorder |
| Payment floor | Government rates (APG equivalent) for OMH Article 31 and OASAS Article 32 ambulatory services |
| Key manual | NYS Medicaid Managed Care Behavioral Health Billing and Coding Manual (OMH, OASAS, DOH) |
| Medicare contractor | National Government Services, Jurisdiction K |
How New York Medicaid pays for behavioral health
Behavioral health became a managed care benefit on October 1, 2015 in New York City and July 1, 2016 in the rest of the state. Mainstream Medicaid managed care plans cover behavioral health for their members. Adults with serious mental illness or substance use disorder can be enrolled in a Health and Recovery Plan (HARP), which adds Community Oriented Recovery and Empowerment (CORE) services. As of August 2025 about 146,000 people were enrolled in HARPs.
State law requires managed care plans to pay at least the Medicaid fee-for-service government rate for outpatient services in OMH-licensed and OASAS-certified programs. These rates are calculated using the APG methodology, and plans process the claims through the state APG grouper or an exact replica. Programs must bill the correct rate code with the procedure codes and modifiers in the state coding taxonomy.
- OMH clinic (Article 31) and OASAS (Article 32) services must use the correct rate code in the claim header.
- Group and family psychotherapy and peer services have state-set APG weight adjustments; missing modifiers can lower payment.
- Pharmacy is billed through NYRx, the Medicaid fee-for-service pharmacy program, not the managed care plan.
- HARP eligibility and CORE service authorization should be checked before services start.
Medicare rules for New York behavioral health providers
Medicare rules are federal, so they are the same in New York as everywhere else. What changes is the contractor: New York clinicians enroll and bill Part B through National Government Services (Jurisdiction K).
- Counselors and MFTs can bill Medicare. Since January 1, 2024, marriage and family therapists and mental health counselors (including LPCs) can enroll in Medicare and bill for their services, paid at 75% of the physician fee schedule amount.
- Home telehealth is permanent for mental health. Patients can receive mental and behavioral health telehealth at home, anywhere in the country, and audio-only is allowed when the patient cannot or does not want to use video.
- The in-person visit rule is delayed. The requirement for an in-person visit within six months before starting tele-mental health, and every 12 months after, is waived until January 1, 2028 under the Consolidated Appropriations Act of 2026. Broader Medicare telehealth flexibilities run through December 31, 2027.
- Incident-to under general supervision. Behavioral health services by auxiliary personnel can be billed incident-to a supervising practitioner under general supervision.
- Tele-prescribing of controlled substances. DEA and HHS extended telemedicine prescribing flexibilities through December 31, 2026.
- Medicare Advantage is different. MA plans set their own networks and prior authorization rules, so we verify each MA plan before the first visit.
New York commercial plan notes
New York has strong mental health parity requirements for state-regulated plans, enforced by the Department of Financial Services. Many OMH and OASAS programs also contract with commercial plans, and those contracts should be checked against the program's licensed service list before billing.
Common behavioral health denials in New York
These are the patterns we see most often with New York behavioral health claims, and each one is preventable with front-end checks:
- Missing or wrong rate code for OMH or OASAS services.
- Underpayments when a plan's APG grouping does not match the state government rate.
- Billing a HARP-only or CORE service for a mainstream plan member.
- Coding taxonomy errors on procedure, modifier and rate code combinations.
- Pharmacy claims sent to the health plan instead of NYRx.
Core behavioral health codes we bill in New York
Psychotherapy codes are time based, so documented start and stop times or total minutes must support the code billed. State Medicaid programs and plans may also require HCPCS codes, modifiers or rate codes on top of these.
| 90791 / 90792 | Psychiatric diagnostic evaluation (without / with medical services) |
|---|---|
| 90832 / 90834 / 90837 | Individual psychotherapy, 16 to 37, 38 to 52, and 53+ minutes |
| 90833 / 90836 / 90838 | Psychotherapy add-ons with an E/M visit |
| 90785 | Interactive complexity add-on |
| 90839 / 90840 | Psychotherapy for crisis, first 60 minutes / each extra 30 |
| 90846 / 90847 / 90853 | Family psychotherapy without / with patient; group psychotherapy |
| 96127 | Brief emotional or behavioral assessment (for example PHQ-9, GAD-7) |
Behavioral health billing services for New York providers
Healthcare Logic works inside your EHR and clearinghouse as an extension of your team. Use one service or the full revenue cycle:
Learn more about our behavioral health revenue cycle services, how we handle behavioral health coding, and credentialing for new clinicians.
Frequently asked questions
What is a HARP in New York?
A Health and Recovery Plan (HARP) is a Medicaid managed care plan for adults with serious mental illness or substance use disorder. It covers the standard Medicaid benefit plus CORE recovery and support services.
Do New York Medicaid plans have to pay the Medicaid rate for behavioral health?
Yes, for OMH-licensed and OASAS-certified ambulatory programs. Managed care plans must pay at least the fee-for-service government rate, calculated using APGs. We audit remittances against that floor to catch underpayments.
Where are New York's behavioral health billing rules published?
OMH publishes the NYS Medicaid Managed Care Behavioral Health Billing and Coding Manual and coding taxonomy, a joint OMH, OASAS and DOH document for mainstream and HARP plans.
Can LMHCs and LMFTs in New York bill Medicare?
Yes. Since January 1, 2024, licensed mental health counselors and marriage and family therapists can enroll in Medicare. In New York they enroll through National Government Services, Jurisdiction K.
How does Healthcare Logic help New York behavioral health providers?
We code and bill to the state taxonomy, manage HARP and mainstream plan rules, audit payments against government rates, work denials and appeals, and keep clinicians credentialed with Medicaid plans, Medicare and commercial payers.
Talk to a behavioral health billing specialist
Tell us your payer mix and EHR, and we will show you where New York claims are getting stuck. Business inquiries only. Reply within 1 business day.
Behavioral health billing in other states
Sources
Payer rules change often. This page reflects official guidance as of October 6, 2026. Confirm current requirements in the state manual and your payer contracts before billing.