NYS Medicaid FFS Billing
AI Summary
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.
Action Required
Immediately: Review and implement updated NYS PCMH billing guidance at health.ny.gov for recognized PCMH providers. Add CPT codes 91110 and 91111 to billing system for wireless capsule endoscopy procedures performed by Medicaid-enrolled gastroenterologists using FDA-cleared devices. Ensure only prescribers or their authorized agents submit prior authorization requests - third party PA requests are prohibited and risk program termination.
Affected Billing Codes
Plan Types
Medicaid
States
NY
Specialties
gastroenterology, family-medicine, internal-medicine