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New York Medicaid: Codes added to Non-Covered Code List
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Sep 2, 2026
Summary
Effective December 1, 2026, UnitedHealthcare Community Plan of New York will add Physical and Occupational Therapy evaluation codes 97161-97168 to its Non-Covered Codes List, aligning with New York State Medicaid policy. Billing teams must stop billing these codes for New York Medicaid members and deny or redirect claims to alternative codes or services.
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What to do
by Nov 30, 2026 · 5 steps
01Billing team must update billing software to flag codes 97161-97168 as non-covered for UnitedHealthcare Community Plan of New York Medicaid members.
02Providers must use alternative evaluation codes or modify documentation per the eMedNY Rehabilitation Services Procedure Codes & Fee Schedule Provider Manual.
03Update claim submission rules to reject or route these codes with denial rationale.
04Notify all PT/OT providers in network of the change.
05Claims submitted after Dec 1, 2026 using codes 97161-97168 for NY Medicaid will be denied.
Codes mentioned
9716197162971639716497165971669716797168
Original notice
New York Medicaid: Codes added to Non-Covered Code List
uhcprovider.com · Always check the source before changing claims.