New York State Medicaid Update - May 2023 Updates to New York State Medicaid Coverage of Coronavirus Disease 2019-Related Services Following the Expiration of the Federally Declared Public Health Emergency Special Edition Volume 39 - Number 7
Updates to New York State Medicaid Coverage of Coronavirus Disease 2019-Related Services Following the Expiration of the Federally Declared Public Health Emergency
The following guidance applies to coronavirus disease 2019 (COVID-19)-related services delivered to New York State (NYS) Medicaid fee-for-service (FFS) members and Medicaid Managed Care (MMC) enrollees after the expiration of the federally declared COVID-19 Public Health Emergency (PHE), which ends on May 11, 2023. Providers are instructed to follow the coverage and billing guidance for COVID-19 related services below.
NYS Medicaid FFS and MMC coverage will continue for the following COVID-19 related services:
- COVID-19 vaccine and vaccine administration coverage will continue.* Providers should continue to follow the coverage policy and billing guidance found in the New York State Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines.
- COVID-19 vaccine and vaccine administration as well as COVID-19 vaccine counseling for members under 21 years of age, provided by School Based Health Centers (SBHCs), will continue.* Providers should continue to follow the coverage policy and billing guidance found in the New York State Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines and COVID-19 Vaccine Counseling provided by School Based Health Centers.
- COVID-19 vaccine counseling coverage for NYS Medicaid members under 21 years of age will continue to be reimbursed as a stand-alone service.* Providers should continue to follow the coverage and billing guidance found in the Updated COVID-19 Vaccine Counseling Coverage guidance or NYS Medicaid members under 21 years of age.
- COVID-19 treatment coverage will continue.* Providers should continue to follow the coverage and billing guidance found in the New York State Medicaid Billing Guidance for COVID-19 Testing, Specimen Collection and Therapeutics.
*Additional guidance will be forthcoming when coverage dates end.
NYS Medicaid FFS and MMC coverage will continue with modifications, effective for dates of service on or after May 12, 2023, for the following COVID-19 related services:
- Effective May 12, 2023, specimen collection ("G2023") and high-throughput testing ("U0003", "U0004", "U0005") will no longer be covered by NYS Medicaid FFS and MMC. Additionally, NYS Medicaid FFS fees for covered COVID-19 related testing will be reduced (home tests will remain $12.00 per test). For individuals enrolled in an MMC Plan, providers must check the MMC Plan of the enrollee for reimbursement and billing guidance. Provider should continue to follow the coverage and billing guidance found in the Updated New York State Medicaid Billing Guidance for COVID-19 Testing, Specimen Collection and Therapeutics.
- SBHCs must continue to follow the coverage and billing guidance found in the Updated New York State Medicaid Billing Guidance for Coronavirus (COVID-19) Testing in School Based Health Centers.
- Effective May 12, 2023, separate payment for COVID-19 vaccine counseling as a stand-alone service for NYS Medicaid members 21 years of age and older will end. COVID-19 vaccine counseling for adults (21 years of age and older) will be included in the Evaluation and Management (E&M) service billed for the patient visit. Providers should continue to follow the coverage and billing guidance found in the Updated COVID-19 Vaccine Counseling Coverage guidance.
Questions and Additional Information:
- FFS coverage and policy questions should be directed to the Office of Health Insurance Programs (OHIP) Division of Program Development and Management (DPDM) by telephone at (518) 473-2160 or by email at FFSMedicaidPolicy@health.ny.gov.
- FFS billing/claim questions should be directed to the eMedNY Call Center at (800) 343-9000.
- MMC enrollment, reimbursement, billing and/or documentation requirement questions should be directed to the specific MMC Plan of the enrollee. MMC Plan contact information can be found in the eMedNY New York State Medicaid Program Information for All Providers - Managed Care Information document.
The Medicaid Update is a monthly publication of the New York State Department of Health.
Kathy Hochul
Governor
State of New York
James McDonald, M.D., M.P.H.
Commissioner
New York State Department of Health
Amir Bassiri
Medicaid Director
Office of Health Insurance Programs
