MedicaidCoverageMedium impact
Continuing Day Treatment Programs 3.01.20
Excellus BlueCross BlueShield·NY · Psychiatry·Behavioral Health (Psychiatry/Psychology)
Effective date
Apr 16, 2026
We identified it
Jun 20, 2026
Summary
New medical policy establishes coverage criteria for Continuing Day Treatment Programs for behavioral health services under New York State Medicaid Managed Care Plans and HARP. Defines specific admission, continuing stay, and discharge criteria that must be met for coverage, with concurrent review required every six months.
Action Required
By April 16, 2026: Billing team must update authorization processes for Continuing Day Treatment Programs to ensure all admission criteria are met before billing revenue code 0970 or HCPCS H2012. Implement six-month concurrent review schedule for ongoing authorizations. Update documentation requirements to include treatment plans within 30 days of admission and quarterly plan reviews. Verify program is licensed by NY State Office of Mental Health before submitting claims.