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MedicaidCoverageMedium impact

Chronic Disease Self-Management Program for Medicaid and HARP

EmblemHealth·NY · Rheumatology, Family Medicine, Internal Medicine +1 more·Provider News
Effective date
Jun 1, 2025
We identified it
Jun 20, 2026
Days to comply

Summary

EmblemHealth will begin covering the Chronic Disease Self-Management Program (CDSMP) for Medicaid and HARP members age 18+ with arthritis diagnoses starting June 1, 2025, using CPT code 98960. This is a new covered benefit for evidence-based group and individual chronic disease management services.

Action Required

Action needed
By June 1, 2025: Providers interested in offering CDSMP services should become certified New York State Medicaid CDSMP providers by following guidelines in the NY State Medicaid Update January 2025. Billing team must add CPT code 98960 to billing system for arthritis self-management programs for EmblemHealth Medicaid/HARP members 18+.

Affected Billing Codes

98960