Contract Guidance on Disenrollment
AI Summary
New York State Medicaid is transitioning to an online Provider Services Portal for all new provider enrollments, with paper applications being phased out by July 2026. The policy also includes obstetric billing changes requiring specific E/M codes with TH modifiers and Category II code 0500F for prenatal care starting June 1, 2026.
Action Required
By June 1, 2026: Obstetric providers must update billing systems to use E/M CPT codes with TH modifier, pregnancy-related O or Z ICD-10 diagnostic codes for all prenatal visits, and include Category II CPT code 0500F for all initial prenatal visits. New providers must use the online Provider Services Portal for enrollment instead of paper applications starting immediately (except single-practitioner groups until July 2026). Update billing software rules and train staff on new portal requirements.
Plan Types
Medicaid
States
NY
Specialties
ob-gyn