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New York State Medicaid Coverage of Nucleic Acid Amplification Testing for the Purpose of Bacterial Vaginosis and Sexually Transmitted Infection Diagnosis and Treatment
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Sep 18, 2026
Summary
New York State Medicaid (both FFS and MMC) clarifies coverage and billing requirements for Nucleic Acid Amplification Tests (NAATs) used to diagnose bacterial vaginosis and sexually transmitted infections. The policy specifies eligible patient populations for testing, approved CPT billing codes, and introduces CPT 81513 effective July 1, 2026. Billing teams must ensure claims are submitted with appropriate clinical documentation supporting medical necessity based on the outlined screening criteria.
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What to do
by Jul 1, 2026 · 5 steps
01Billing team must update billing system to recognize and process CPT 81513 (Measurement of RNA of Bacteria in Vaginal Fluid Specimen) for NYS Medicaid claims.
02Update claim submission rules to ensure NAAT codes (81513, 87481, 87494, 87529, 87563, 87661, 87798, 87801) are only billed when patients meet documented screening criteria per policy (e.g., sexually active women under 25, pregnant women at risk, MSM populations, etc.).
03Providers must document in medical records which screening criteria justified the NAAT order.
04For Medicaid FFS questions, contact (518) 473-2160 or FFSMedicaidPolicy@health.ny.gov.
05For MMC claims issues, contact eMedNY at (800) 343-9000 or the specific MMC Plan.
If missed: Failure to document medical necessity will result in claim denials.
Codes mentioned
8151387481874948752987563876618779887801
Original notice
New York State Medicaid Coverage of Nucleic Acid Amplification Testing for the Purpose of Bacterial Vaginosis and Sexually Transmitted Infection Diagnosis and Treatment
health.ny.gov · Always check the source before changing claims.