September 9, 2024

The Commercial Fee-Schedule (Non-APG) just went live on OMHs commercial billing webpage: Commercial Billing for Behavioral Health (BH) Services (ny.gov)   Here is the specific URL link to the fee schedule: https://omh.ny.gov/omhweb/bho/commercial-fee-schedule-non-apg-omh-licensed-outpatient.xlsx   OMH will be distributing this information to insurers shortly.  I’m watching the OASAS site for similar information.  

Here’s the OMH page at the first link (embedded above):

Commercial Billing for Behavioral Health (BH) Services

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Billing Rate Updates and Requirements | Billing Guidance | Contact Information

This page is for commercial health insurers and behavioral health providers. It provides guidance on complying with laws related to commercial reimbursement and billing for OMH-licensed ambulatory programs.

Billing Rate Updates and Requirements

Commercial Fee Schedule for Non-APG OMH-licensed Outpatient Services (August 29, 2024)

Part AA of Chapter 57 of the Laws of 2024 requires insurers to reimburse covered outpatient mental health and substance use disorder services provided by in-network OMH and OASAS facilities. The rates cannot be less than the Medicaid rates for those services.

This workbook provides minimum Medicaid reimbursement rates for OMH outpatient services (excluding APG) applicable to Part AA.

MHOTRS APG Weight Schedule (May 8, 2024)
A resource for Commercial Plans listing possible combinations of procedures, modifiers, and other elements to determine the final APG weight. The final weight can be used with the base rate identified in the APG rate file to calculate reimbursement for MHOTRS (including School-Based Mental Health Clinic services).

• School-Based Mental Health Clinic Program Site List (updated weekly)
  A resource for Commercial Plans listing school-based mental health clinic sites with provider IDs, NPIs, rate codes, and rates.

The APG CPT Revenue Calculator allows users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates for services delivered by OMH-licensed MHOTRS Programs.

• APG CPT Revenue Calculator: Illustrated
• APG CPT Revenue Calculator: Blank

Department of Health (DOH) Ambulatory Patient Group (APG) Rates
This page houses provider-specific base rates for APGs.

Billing Guidance

Department of Financial Services (DFS) Insurance Circular Letter No. 9 (2023)
Reimbursement for Treatment Provided by School-Based Mental Health (SBMHC) Clinics

Commercial Coverage for Services Provided by OMH-Licensed SBMH Clinics FAQs (July 12, 2024)
Responds to questions received from providers.

School-Based Mental Health (SBMH) Clinic FAQs for Commercial Billing (March 1, 2024)
Responds to questions received from commercial insurers.

Webinar: Reimbursement for Services provided by OMH-licensed School-Based Mental Health Clinics for Commercial Plans (CTAC-MCTAC login required).

This webinar covers:

• School-Based Mental Health Clinic reimbursement requirements.
• Guidance and resources, including rates and billing information.

Contact Information

• For questions regarding commercial billing for OMH licensed services, please contact: commercial-billing@omh.ny.gov
• For provider complaints regarding behavioral health services billed under commercial insurance, please go to: File a Complaint | Department of Financial Services (ny.gov)

Please contact OMH Commercial Billing with any questions, comments, or problems you may be experiencing with this site.