What types of policy changes does NY Medicaid issue?

NY Medicaid regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does NY Medicaid update its policies?

NY Medicaid typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many NY Medicaid policy changes are tracked here?

This page currently tracks 18 documented NY Medicaid policy changes. New items are added as they are identified.

What should I do when NY Medicaid changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

NY Medicaid Policy Changes & Prior Auth Updates

We track 18 documented policy changes from NY Medicaid across NY. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original NY Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new NY Medicaid updates automatically.

Medium impact
Coverage of Healthcare Common Procedure Coding System "G2211": Add-On Code for Complex Pediatric Care
NY Medicaid·Identified May 24, 2026
New York State Medicaid now covers HCPCS code G2211 as an add-on code for complex pediatric care services. This policy is part of the April 2026 Medicaid Update and represents a new billing opportunity for pediatric providers treating complex cases.
Medium impact
Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid is updating fee schedules for physician, nurse practitioner, and midwife services. For obstetric care, providers must use E/M CPT codes with TH modifier and include Category II CPT code 0500F for initial prenatal visits for patients initiating care on/after June 1, 2026.
Medium impact
Submission of Secondary Claims to New York State Medicaid and Use of Claim Adjustment Reason Codes
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid now requires specific billing procedures for secondary claims and claim adjustment reason codes. For obstetric services, providers must use E/M CPT codes with TH modifier, pregnancy-related ICD-10 codes, and include Category II CPT code 0500F for initial prenatal visits when care initiates on/after June 1, 2026.
High impact
Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes
NY Medicaid·Effective Jun 1, 2026
Effective for prenatal care starting June 1, 2026, New York Medicaid requires providers to use E/M CPT codes with TH modifier, pregnancy-related O or Z ICD-10 codes for all prenatal visits, and Category II CPT code 0500F for initial prenatal visits. Current billing practices continue for established prenatal care until December 31, 2026.
Medium impact
Contract Guidance on Disenrollment
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid is transitioning to an online Provider Services Portal for all new provider enrollments, with paper applications being phased out by July 2026. The policy also includes obstetric billing changes requiring specific E/M codes with TH modifiers and Category II code 0500F for prenatal care starting June 1, 2026.
Medium impact
Reminder: Disenrollment Rules and Recovery Rules for Mainstream Medicaid Managed Care, Health and Recovery Plans, and Special Needs Plans
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid has updated disenrollment and recovery rules for managed care plans, emphasizing that the state retains the right to recover capitation payments even without proper disenrollment notices. Additionally, new obstetric billing requirements take effect for prenatal care starting June 1, 2026, requiring E/M codes with TH modifiers and specific diagnostic codes.
Medium impact
Continued Development of the New York State Medicaid Provider Services Portal: New Enrollment for All Provider Types Now Available
NY Medicaid·Effective Jun 1, 2026
New York State Medicaid is transitioning to an online Provider Services Portal (PSP) for new provider enrollment. All new providers except single-practitioner group practices must now use the online portal instead of paper applications, with paper applications being completely discontinued by July 2026.
Low impact
Pharmacy Reminder: Coordination of Benefits Processing Instructions for New York State Medicaid
NY Medicaid·Identified May 10, 2026
New York State Medicaid has issued a reminder about coordination of benefits processing instructions for pharmacy claims. This appears to be guidance reinforcement rather than a new policy change, focusing on proper coordination when patients have multiple insurance coverages.
Low impact
Clarification and Reminder: Pharmacy Providers Servicing Requirements for NYRx Members
NY Medicaid·Identified May 10, 2026
New York State Medicaid has issued a clarification reminder regarding pharmacy provider servicing requirements for NYRx members. This policy reinforces existing requirements for pharmacy providers serving Medicaid members in New York's pharmacy program.
Medium impact
NYRx Pharmacy Drug Coverage: Claims Processing Enhancements and Reminders
NY Medicaid·Effective Jan 1, 2026
New York State Medicaid has updated prior authorization requirements for pharmacy claims, prohibiting third-party entities from submitting PA requests and clarifying that only prescribers or their authorized agents may request prior authorizations. The policy also provides updated coverage criteria for wireless capsule endoscopy procedures.
Low impact
Medicaid Breast Cancer Surgery Centers
NY Medicaid·Identified May 10, 2026
New York State Medicaid has updated coverage criteria for wireless capsule endoscopy, specifying when the procedure is covered and contraindications. The policy requires trained gastroenterologists to perform the procedure using FDA-cleared devices, with documentation requirements and specific billing codes.
Medium impact
2026 Spousal Impoverishment Income and Resource Levels Increase
NY Medicaid·Identified May 10, 2026
New York State Medicaid updated coverage criteria for wireless capsule endoscopy, specifying that it's only covered when conventional endoscopy cannot identify pathology or is contraindicated, and must be performed by Medicaid-enrolled gastroenterologists using FDA-cleared devices. Colon cancer screening is explicitly excluded from coverage.
Medium impact
New Policy Allowing for Treatment in Place Payments for New York State Medicaid
NY Medicaid·Identified May 10, 2026
New York State Medicaid now allows for Treatment in Place payments, providing new reimbursement opportunities for qualifying providers treating Medicaid members at their current location rather than requiring transport or facility-based care.
Low impact
Expansion of Remote Patient Monitoring Delivered by Clinical Staff and for Prenatal/Postpartum Services
NY Medicaid·Identified May 10, 2026
New York State Medicaid expanded coverage for remote patient monitoring services delivered by clinical staff and for prenatal/postpartum care. The policy document mentions this expansion but does not provide specific implementation details, billing codes, or requirements.
High impact
Prohibited Prior Authorization Requests
NY Medicaid·Identified May 10, 2026
New York State Medicaid now prohibits third-party entities from submitting prior authorization requests on behalf of prescribers. Only prescribers or their authorized agents (employees with access to patient medical records) may submit PA requests, and outsourcing this function is banned.
Medium impact
NYS Medicaid FFS Billing
NY Medicaid·Effective Jan 1, 2026
NYS Medicaid updated billing guidance for Patient Centered Medical Homes and coverage criteria for wireless capsule endoscopy, adding new CPT codes 91110 and 91111 for digestive tract imaging procedures. The policy also reinforces that only prescribers or their authorized agents may submit prior authorization requests.
Medium impact
New York State Medicaid Updated Coverage Criteria for Wireless Capsule Endoscopy
NY Medicaid·Identified May 10, 2026
New York State Medicaid updated coverage criteria for wireless capsule endoscopy, specifying it's only covered when conventional endoscopy can't identify pathology or is contraindicated. The policy excludes colon cancer screening and requires FDA-cleared devices used by trained gastroenterologists with specific documentation requirements.
Medium impact
Update to the New York State Patient Centered Medical Home Billing Guidance
NY Medicaid·Effective Jan 1, 2026
New York State Medicaid updated Patient Centered Medical Home billing guidance effective January 1, 2026, including updated payment tables, quality reporting requirements, and provider revocation risk information. The policy also updated coverage criteria for wireless capsule endoscopy with specific billing codes and medical necessity requirements.

NY Medicaid in NY NY Medicaid: Emergency Medicine NY Medicaid: Family Medicine NY Medicaid: Gastroenterology NY Medicaid: General Practice All payers

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Coverage of Healthcare Common Procedure Coding System "G2211": Add-On Code for Complex Pediatric Care

Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services

Submission of Secondary Claims to New York State Medicaid and Use of Claim Adjustment Reason Codes

Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes

Contract Guidance on Disenrollment

Reminder: Disenrollment Rules and Recovery Rules for Mainstream Medicaid Managed Care, Health and Recovery Plans, and Special Needs Plans

Continued Development of the New York State Medicaid Provider Services Portal: New Enrollment for All Provider Types Now Available

Pharmacy Reminder: Coordination of Benefits Processing Instructions for New York State Medicaid

Clarification and Reminder: Pharmacy Providers Servicing Requirements for NYRx Members

NYRx Pharmacy Drug Coverage: Claims Processing Enhancements and Reminders

Medicaid Breast Cancer Surgery Centers

2026 Spousal Impoverishment Income and Resource Levels Increase

New Policy Allowing for Treatment in Place Payments for New York State Medicaid

Expansion of Remote Patient Monitoring Delivered by Clinical Staff and for Prenatal/Postpartum Services

Prohibited Prior Authorization Requests

NYS Medicaid FFS Billing

New York State Medicaid Updated Coverage Criteria for Wireless Capsule Endoscopy

Update to the New York State Patient Centered Medical Home Billing Guidance