April 10, 2024
Good morning,
Did you know that OMH now has a page on their Website devoted to commercial billing for mental health services? For NYS Council members that operate school-based mental health satellites this information may prove useful. Here’s the link: https://omh.ny.gov/omhweb/bho/billing-services.html#commercial
And, don’t forget –– the NYS Council Website: www.nyscouncil.org includes archived recordings and powerpoint presentations from our 2021 NYS Council Contracting series facilitated by our attorney Adam Falcone. The training takes a deep dive into the contracting process to include a review of ‘red flag’ phrases and clauses that are not favorable for providers (and sometimes prohibited from inclusion in the contract as determined by NYS ). It also includes advice for negotiating with insurers as well as favorable terms you’ll want to build into your contract/s.
You will need a UserName and Password to access this part of our Website. Just send us a note and we will issue you credentials. Write to Cindy Levernois at: cindy@nyscouncil.org to request credentials.
On the OMH webpage you will find the following:
Commercial BH Billing Guidance
- Department of Financial Services (DFS) Insurance Circular Letter No. 9 (2023): Reimbursement for Treatment Provided by School-Based Mental Health (SBMHC) Clinics
APG CPT Revenue Calculator: This tool enables users to calculate the projected revenue for CPT procedures based on current service weights and peer group base rates. Commercial carriers are required to pay the Medicaid Rate (also known as “government rate”) for OMH licensed SBMH Clinic effective January 1, 2024. The following calculators are for identifying Medicaid APG rates for SBMH Clinic services. Commercial Plans can also reference it to calculate the reimbursement for SBMH Clinic services.
- 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. (Article 31s are included
- 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.
- School-Based Mental Health Clinic Fee Schedule (October 6, 2023) – A resource for Commercial Plans listing possible combinations of procedures, modifiers, and other elements to determine the final weight. The final weight can be used with the base rate identified in the School-Based Mental Health Clinic Program Site List (above) to calculate reimbursement for school-based mental health clinic services.
- Reimbursement for Services provided by OMH-licensed School-Based Mental Health Clinics: for Commercial Plans Webinar
This webinar covers:- 1. School-Based Mental Health Clinic reimbursement requirements
- 2. Guidance and resources, including rates and billing information for School-Based Mental Health Clinics
Questions/Complaints
- For questions regarding commercial billing for OMH-licensed School-Based Mental Health Clinic 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)