Excellus BlueCross BlueShieldMedicaid · Coverage · Behavioral Health (Psychiatry/Psychology) · NY · PsychiatryMedium impact
Continuing Day Treatment Programs 3.01.20
Effective date
Apr 16, 2026
Identified
Jun 20, 2026
Summary
Excellus BlueCross BlueShield medical policy 3.01.20 has a current effective date of April 16, 2026. Continuing Day Treatment programs licensed or operated by the New York State Office of Mental Health are eligible for coverage under New York State Medicaid Managed Care Plans and Health and Recovery Plans (HARP). Admission requires evaluation by a licensed clinician, a designated mental illness diagnosis, a related dysfunction that cannot be adequately provided in a lower level of care, and no need for 24-hour supervision. Concurrent review and authorizations occur at six-month intervals, and continued stay requires progress toward treatment goals, coordination of care, active discharge planning, and no less intensive level of care that would be adequate. A written individual treatment plan must be completed before the 12th visit or within 30 days of admission, whichever occurs first, and reviewed at least every three months. The 2026 annual review left policy intent unchanged.
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01Already effective April 16, 2026: Billing team: for Continuing Day Treatment services under New York State Medicaid Managed Care Plans and HARP, confirm the program is licensed or operated by the New York State Office of Mental Health.
02Obtain concurrent review and authorization at six-month intervals.
03Document that the individual continues to meet admission criteria, continues to make progress toward treatment goals, and continues to require services at this level of care, with documentation of coordination of care and active discharge planning throughout treatment.
04Confirm a written individual treatment plan is completed before the 12th visit or within 30 days of admission, whichever occurs first, and reviewed at least every three months.
05Revenue code 0970 is listed for Behavioral Health Treatments/Services, Community Behavioral Health Program (Day Treatment).
Codes mentioned
H2012
Original notice
Continuing Day Treatment Programs 3.01.20
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