Updates to the OMH Commercial Billing Webpage

September 9, 2025

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Good afternoon,

This email announces newly published updates to the Commercial Billing for Behavioral Health (BH) Services webpage to support the implementation of Part AA of Chapter 57 of the Laws of 2024 (Part AA). The below fee schedules (Exhibits A through E) were updated to include commercial benchmark rates effective January 1, 2026, along with the active rates that became effective January 1, 2025. Please note that rates for 2026 are pending DOB approval; an additional notice will be sent once approval is received.

As a reminder, the Part AA commercial rate mandate applies to in-network, fully insured individual and group comprehensive health insurance policies and contracts issued in New York State. Part AA does not apply to self-funded coverage. For additional details on the scope/ applicability of Part AA, please refer to the following resources: FAQ #1, FAQ#2, FAQ#3.

Providers are encouraged to reach out to OMH with any questions, issues, or concerns. Providers can contact OMH Commercial Billing at commercial-billing@omh.ny.gov for:

  • Informational support regarding plan requirements and applicability,
  • Review of claims reimbursement-related issues and guidance on how to proceed,
  • Support for preparing complaints to DFS on Part AA compliance. 

Sincerely,

OMH Commercial Billing

Updated Fee Schedules & Rate Tools

  1. Exhibit A – APG Base Rates for MHOTRS Providers

Contains 2025 and 2026 provider-specific APG Base Rates (including School-Based Mental Health Clinic services), with associated rate codes.

  1. Exhibit B – MHOTRS APG Weight Schedule

For Commercial Plans listing possible combinations of procedures, modifiers, and other elements to determine the final APG weight.

  1. Exhibit C – Non-APG OMH Outpatient Services Fee Schedule

Contains 2025 and 2026 fee schedules for OMH outpatient services applicable to Part AA that are not priced using APG methodology. Includes: applicable rate codes, procedure codes, modifiers, and units of service.

  1. Exhibit D – Non-APG OMH Provider-Level Fee Schedule

Contains 2025 and 2026 provider-specific rates for non-APG OMH outpatient services applicable to Part AA.

  1. Exhibit E – MHOTRS APG OMH Outpatient Fee Schedule

Contains 2025 and 2026 fee schedules for OMH outpatient services applicable to Part AA that are priced using APG methodology. This document can be used to determine the final price for every MHOTRS outpatient behavioral health service billed by an OMH-licensed provider, according to Peer Group.