Health Home Rate Codes
- Rate Codes are also available in Portable Document Format (PDF)
Fee schedule effective 4/1/2026
| *The 4/1/2026 fees are pending approval. |
|---|
| *Upstate - All Other NYS Counties not listed as Downstate **Downstate - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester ***Rates only apply to impacted Adult Home class members |
| Current rates (as of cycle 2511) | Pending rates | |||||||
|---|---|---|---|---|---|---|---|---|
| 2.6% Targeted Inflationary Increase (TII) | 2.7% Targeted Inflationary Increase (TII)* | |||||||
| 4/1/2025 | 4/1/2026* | |||||||
| Rate Code | eMedNY Description | Revenue Code | Procedure Code | Modifier | Upstate* | Downstate** | Upstate* | Downstate** |
| Health Homes Serving Children (HHSC) | ||||||||
| 1864 | HEALTH HOME SERVICES - CHILDREN (LOW) | 0500 | T2022 | U1 | 243.00 | 276.00 | 243.00 | 276.00 |
| 1865 | HEALTH HOME SERVICES - CHILDREN (MED) | 0500 | T2022 | U2 | 485.00 | 553.00 | 485.00 | 553.00 |
| 1866 | HEALTH HOME SERVICES - CHILDREN (HIGH) | 0500 | T2022 | U3 | 809.00 | 921.00 | 809.00 | 921.00 |
| 1867 | HEALTH HOME SERVICES-CHILDREN (HIGH FIDELITY WRAP) | 0500 | T2022 | U4 | 1,228.00 | 1,399.00 | 1,228.00 | 1,399.00 |
| 1868 | HEALTH HOME - CANS ASSESSMENT (CHILDREN) | 0500 | G0506 | NONE | 186.85 | 186.85 | ||
| 1869 | HEALTH HOME SERVICES - CHILDREN (LOW) (INC FFP) | 0500 | T2022 | U1 | 243.00 | 276.00 | 243.00 | 276.00 |
| 1870 | HEALTH HOME SERVICES - CHILDREN (MED) (INC FFP) | 0500 | T2022 | U2 | 485.00 | 553.00 | 485.00 | 553.00 |
| 1871 | HEALTH HOME SERVICES - CHILDREN (HIGH) (INC FFP) | 0500 | T2022 | U3 | 809.00 | 921.00 | 809.00 | 921.00 |
| 1875 | HEALTH HOME HCBS LOC ASSESSMENT FEE | 0500 | G0506 | U1 | 200.00 | 200.00 | ||
| Health Homes Serving Adults (HHSA) | ||||||||
| 1860 | HEALTH HOME SERVICES - ADULT HOME TRANSITION*** | 0500 | G9005 | U3 | 800.00 | 800.00 | ||
| 1861 | ADULT HOME ASSESSMENT AND MANAGEMENT FEE*** | NONE | NONE | NONE | 200.00 | 200.00 | ||
| 1873 | HEALTH HOME CARE MANAGEMENT | 0500 | G9005 | U1 | 202.00 | 215.13 | 202.00 | 215.13 |
| 1874 | HEALTH HOME HIGH RISK/NEED CARE MGMT | 0500 | G9005 | U2 | 363.60 | 386.83 | 363.60 | 386.83 |
| Health Homes Plus (HH+) | ||||||||
| 1853 | HEALTH HOME PLUS/CARE MANAGEMENT | 0500 | G9005 | U4 | 867.45 | 925.28 | 890.87 | 950.26 |
| 1876 | HEALTH HOME PLUS/AOT | 0500 | G9005 | U6 | 1,046.64 | 1,115.19 | 1,074.90 | 1,145.30 |
Please note:
- There is a special set of rates that Health Home entities can use to participate in Community Health Worker (CHW) service provision. The CHW policy manual, fee schedule, billing guidelines and codes can be found on the eMedNY CHW Services website.
- The Health and Recovery Plan (HARP) BH HCBS Fee Schedule can be found on the Office of Mental Health's (OMH) website under the heading "Reimbursement Rates only available through Medicaid Managed Care Organizations (MMCOs)".
