MedicaidCoverageHigh impact
Spread the Word: New York State Medicaid Advisory Committee and Beneficiary Advisory Council
NY Medicaid·NY · Dentistry, Pharmacy, Wound Care +3 more·Provider Bulletin
Effective date
Jul 29, 2026
We identified it
Sep 18, 2026
Summary
NYS Medicaid issued four major policy updates effective July 29, 2026: (1) Telehealth Policy Manual updates including new CPT codes 99445 and 99470, revised Remote Patient Monitoring tables, and teledentistry billing grids; (2) NYRx compounded pharmacy policy clarifying reimbursement criteria and excluding certain topical ingredients; (3) Patient Centered Medical Home (PCMH) Billing Guidance updates with new payment tables and quality reporting requirements; and (4) Hyperbaric Oxygen Therapy (HBOT) coverage policy limiting reimbursement to specific acute and adjunctive conditions with strict documentation requirements.
Action Required
By July 29, 2026: (1) BILLING TEAM: Update billing software to recognize new CPT codes 99445 and 99470 for telehealth services; rebuild Remote Patient Monitoring (RPM) procedure code tables per revised manual categories; update CPT 99407 rate information in fee schedules. (2) TELEHEALTH/DENTAL STAFF: Review and implement revised teledentistry billing grids by site and location; implement new collaborative practice Registered Dental Hygienist (RDH) model billing grid. (3) PHARMACY BILLING: Stop using Submission Clarification Code (SCC) '08' for compounded products with excluded ingredients or indications; update system to block claims for topical compounds containing anticonvulsants, NSAIDs, skeletal muscle relaxants, tricyclic antidepressants, or non-FDA-approved ingredients. (4) PCMH PROVIDERS: Update attestation information on Health Commerce System (HCS) if practice information has changed; implement new quality metrics reporting per updated PCMH manual. (5) HBOT PROVIDERS: Implement strict documentation requirements limiting HBOT coverage to: acute carbon monoxide intoxication, decompression illness, gas embolism, gas gangrene, AND adjunctive therapy only for acute traumatic peripheral ischemia, crush injuries, reattachment, necrotizing infections, acute arterial insufficiency, skin graft preservation, chronic refractory osteomyelitis, osteoradionecrosis, actinomycosis, or diabetic lower extremity wounds (Wagner grade III+) after 30 days failed standard therapy. Claims submitted outside these parameters will be denied. Reference NYS Department of Health telehealth/PCMH webpages for full manuals; contact eMedNY (800-343-9000) for billing questions or telehealth.policy@health.ny.gov for coverage questions.