NY MedicaidMedium ImpactBilling Codes
Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services
Published May 24, 2026Effective June 1, 2026
AI Summary
New York State Medicaid is updating fee schedules for physician, nurse practitioner, and midwife services. For obstetric care, providers must use E/M CPT codes with TH modifier and include Category II CPT code 0500F for initial prenatal visits for patients initiating care on/after June 1, 2026.
Action Required
By June 1, 2026: Billing team must update obstetric billing procedures to use E/M CPT codes with TH modifier for prenatal visits, add 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 for patients initiating care on/after June 1, 2026. Update billing system rules and encounter forms accordingly.
Plan Types
Medicaid
States
NY
Specialties
ob-gyn, family-medicine