MedicaidBilling CodesHigh impact
Acceptable Procedure Code/Modifier Combinations
Healthfirst·NY·Provider Update
Effective date
Sep 1, 2023
We identified it
Jun 20, 2026
Summary
Effective September 1, 2023, Healthfirst will automatically deny claims with invalid or inactive procedure code/modifier combinations based on NYSM, AMA, and CMS guidelines. Claims will receive specific denial codes (CARC 16, RARC N823) and must be corrected and resubmitted with valid code/modifier combinations.
Action Required
By September 1, 2023: Billing team must verify all procedure code/modifier combinations comply with NYSM, AMA, and CMS guidelines before claim submission. Update billing system validation rules to flag invalid combinations. When claims are denied with CARC 16/RARC N823, review and resubmit corrected claims with appropriate code/modifier combinations per Healthfirst Provider Manual guidelines.