MedicaidCoverageHigh impact
Update to the New York State Medicaid Telehealth Policy Manual
NY Medicaid·NY · Dentistry, Wound Care·Telehealth
Effective date
Jul 29, 2026
We identified it
Sep 18, 2026
Summary
New York State Medicaid released three major policy updates effective July 29, 2026: (1) Telehealth Policy Manual updates including new CPT codes 99445 and 99470, revised eTriage guidance, reorganized RPM codes, and teledentistry billing changes; (2) Patient Centered Medical Home Billing Guidance updates with clarified MMC enrollee assignment, new quality metrics, and updated payment tables; and (3) Hyperbaric Oxygen Therapy (HBOT) coverage policy establishing reimbursement limits to specific acute conditions and adjunctive therapies with strict clinical criteria for diabetic wounds.
Action Required
By July 29, 2026: (1) Billing team must update billing software to recognize and properly bill new telehealth CPT codes 99445 and 99470 per the updated NYS Medicaid Telehealth Policy Manual; update Remote Patient Monitoring (RPM) code tables and rate information for CPT 99407; and integrate revised teledentistry billing grids by site and location, including the new RDH collaborative practice model grid. (2) Verify PCMH payment table alignment for fee-for-service, MMC, Child Health Plus, and Adirondack program in billing system; ensure practice information is current in Health Commerce System (HCS). (3) Implement HBOT billing restrictions: restrict reimbursement to Article 28 hospital-based settings only; establish prior authorization protocols requiring documentation that diabetic wound patients have failed 30+ days of standard wound therapy and meet Wagner grade III or higher criteria before billing HBOT; remove coverage for HBOT when used for non-covered indications. Providers must document specific covered conditions (acute carbon monoxide intoxication, decompression illness, gas embolism, gas gangrene) and adjunctive therapy clinical criteria in patient records. Contact eMedNY Call Center (800) 343-9000 for billing questions, telehealth.policy@health.ny.gov for telehealth coverage questions, or NYRx@health.ny.gov for pharmacy compounding questions. Failure to implement these changes will result in claim denials and potential compliance issues.