New York Medicaid (eMedNY)

MedicaidNY

ABA billing requirements · Source: New York eMedNY — ABA Provider Policy Manual

High confidence

Verified 2026-03-01

1 active policy alert

New York Medicaid 12.5% rate cut (second phase) scheduled for April 2026Effective 2026-04-01

New York's FY2025 budget included a 25% ABA rate reduction to be phased in as two 12.5% cuts. The first cut was implemented. The second 12.5% cut is scheduled for April 2026. A CASP/NYSABA survey found 72% of providers will exit NY Medicaid if the second cut takes effect. Legislative advocacy is ongoing.

Authorization Requirements

Requires prior auth Yes

Initial auth durationN/A

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceEvery 6 months

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

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsReason for referral, Background information, Behavioral assessment method and results, Treatment setting, Treatment goals, Plan for coordination with other providers, Plans for transition and discharge of services

Progress summary cadenceEvery 6 months

Policy Notes

ABA services are covered for members under 21 with ASD or Rett Syndrome. A referral from a NYS-licensed and Medicaid-enrolled physician or other specified professional is required. Treatment plans must be updated at least every 6 months. LBAs must supervise unlicensed individuals for a minimum of 5% of hours monthly, with at least two face-to-face contacts.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for New York Medicaid (eMedNY).

Official policy source:New York eMedNY — ABA Provider Policy Manual

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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