HealthFirst (NY Medicaid)

MedicaidNY

ABA billing requirements · Source: HealthFirst — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerOptum

State licensure requiredLBA (NY Education Department Office of the Professions)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

HealthFirst is a not-for-profit New York Medicaid MCO covering ~1.5M members in NYC metro. ABA prior auth required. Behavioral health managed through Optum. BCBA must be enrolled with HealthFirst and New York Medicaid.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for HealthFirst (NY Medicaid).

Official policy source:HealthFirst — Provider Resources (Behavioral Health)

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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