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[New York] Billing changes for Adult and Youth Assertive Community Treatment (ACT)
Act
by Oct 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026
Summary
New York Medicaid is replacing six legacy ACT (Assertive Community Treatment) rate and procedure codes (4508, 4509, 4511, 4513, 4514, 4515) with new billing codes and modifiers that distinguish between adult vs. youth programs and capacity slot levels (full, partial, inpatient service). Effective January 1, 2027, ACT providers must stop using old codes and transition to the new billing structure.
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What to do
by Oct 31, 2026 · 4 steps
01Billing team must (1) contact Jessica.Jarvis-Guay@anthem.com with your NPI and TIN to opt into claims testing for new ACT billing codes; (2) obtain the complete OMH mandate and new rate code/procedure code/modifier mapping from the referenced notification link.
02By December 31, 2026: (1) Update billing software to discontinue use of rate codes 4508, 4509, 4511, 4513, 4514, 4515; (2) implement new billing codes and modifiers for adult and youth ACT services based on population type and capacity slot level (100, 68, 48, 36 for adult; 68, 48, 36, 28 for youth); (3) retrain billing and provider staff on new coding requirements; (4) test claims in production system using Anthem's testing resources.
03Effective January 1, 2027: Stop all billing using legacy codes.
04Any claims submitted with codes 4508-4515 after the effective date will be denied.
Original notice
[New York] Billing changes for Adult and Youth Assertive Community Treatment (ACT)
providernews.anthem.com · Always check the source before changing claims.