MedicaidCoverageHigh impact
New York Medicaid: Codes added to Non-Covered Code List
UnitedHealthcare·NY · Physical Therapy, Occupational Therapy·State news
Effective date
Dec 1, 2026
We identified it
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.
Action Required
By November 30, 2026: Billing team must update billing software to flag codes 97161-97168 as non-covered for UnitedHealthcare Community Plan of New York Medicaid members. Providers must use alternative evaluation codes or modify documentation per the eMedNY Rehabilitation Services Procedure Codes & Fee Schedule Provider Manual. Update claim submission rules to reject or route these codes with denial rationale. Notify all PT/OT providers in network of the change. Claims submitted after Dec 1, 2026 using codes 97161-97168 for NY Medicaid will be denied.