MedicaidCoverageHigh impact
Reminder: Non-Covered Codes for Medicaid Managed Care and Child Health Plus Reimbursement Policy Effective Feb. 1, 2026
Healthfirst·NY·Provider Update
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Healthfirst will deny claims with CPT and HCPCS codes not included in New York State Medicaid fee schedules for Medicaid Managed Care, HARP, and Child Health Plus plans. Providers must verify code coverage through eMedNY guidelines and use only covered codes or risk denials and compliance reviews.
Action Required
Before February 1, 2026: Billing team must verify all CPT and HCPCS codes against New York State Medicaid fee schedules via eMedNY website before submitting claims for MMC, HARP, and CHP patients. Update billing system to flag non-covered codes for these plan types. Train staff to use Healthfirst Provider Portal for member eligibility verification. Replace non-covered codes with appropriate covered codes or bundle services when applicable. Claims with non-covered codes will be denied and may trigger compliance reviews.