Health Home Rate Codes
- Rate Codes are also available in Portable Document Format (PDF)
| Health Home Rate Codes in Effect for Health Home Services on/after April 1, 2025 ***pending State/Federal approval (Rate changes are highlighted in blue |
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| Rates Effective April 1, 2023 | Rates Effective January 1, 2024 | Rates Effective April 1, 2024 | Rates Effective April 1, 2025 *** | |||||||||
| Rate Code | Rate Description and Applicable To | Revenue Code | Procedure Code | Modifier | Upstate (1) | Downstate(1) | Upstate (1) | Downstate(1) | Upstate (1) | Downstate(1) | Upstate (1) | Downstate(1) |
| 1853 | Health Home Plus/Care Management (Adults) | 0500 | G9005 | U4 | $822.12 | $876.93 | $822.12 | $876.93 | $845.47 | $901.83 | $867.45 | $925.28 |
| 1860 | Health Home Services - Adult Home Transition (Adult Home Class Members)(2) | 0500 | G9005 | U3 | $800.00 | $800.00 | $800.00 | $800.00 | ||||
| 1861 | Adult Home Assessment and Management Fee (Adult Home Class Members)(2) | NONE | NONE | NONE | $200.00 | $200.00 | $200.00 | $200.00 | ||||
| 1864 | Health Home Services - Children (Low) | 0500 | T2022 | U1 | $227.25 | $242.40 | $243.00 | $276.00 | $243.00 | $276.00 | $243.00 | $276.00 |
| 1865 | Health Home Services - Children (Medium) | 0500 | T2022 | U2 | $454.50 | $483.79 | $485.00 | $553.00 | $485.00 | $553.00 | $485.00 | $553.00 |
| 1866 | Health Home Services - Children (High) | 0500 | T2022 | U3 | $757.50 | $806.99 | $809.00 | $921.00 | $809.00 | $921.00 | $809.00 | $921.00 |
| 1867 | High Fidelity Wrap (HFW) (Children) | 0500 | T2022 | U4 | $1,228.00 | $1,399.00 | $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 | $186.85 | $186.85 | $186.85 | $186.85 | $186.85 | $186.85 |
| 1869 | Health Home Services - Children (Low) (Inc FFP) | 0500 | T2022 | U1 | $227.25 | $242.40 | $243.00 | $276.00 | $243.00 | $276.00 | $243.00 | $276.00 |
| 1870 | Health Home Services - Children (Medium) (Inc FFP) | 0500 | T2022 | U2 | $454.50 | $483.79 | $485.00 | $553.00 | $485.00 | $553.00 | $485.00 | $553.00 |
| 1871 | Health Home Services - Children (High) (Inc FFP) | 0500 | T2022 | U3 | $757.50 | $806.99 | $809.00 | $921.00 | $809.00 | $921.00 | $809.00 | $921.00 |
| 1873 | Health Home Care Management (Adults) | 0500 | G9005 | U1 | $202.00 | $215.13 | $202.00 | $215.13 | $202.00 | $215.13 | $202.00 | $215.13 |
| 1874 | Health Home High Risk/Need Care Management (Adults) | 0500 | G9005 | U2 | $363.60 | $386.83 | $363.60 | $386.83 | $363.60 | $386.83 | $363.60 | $386.83 |
| 1875 | Home and Community Based Services Assessment Fee (Children) | 0500 | G0506 | U1 | $200.00 | $200.00 | $200.00 | $200.00 | $200.00 | $200.00 | $200.00 | $200.00 |
| 1876 | Health Home Plus/AOT (Adults) | 0500 | G9005 | U6 | $1,020.12 | $1,086.93 | $1046.64 | $1115.19 | ||||
NOTES: |
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| (1) Downstate includes NYC, Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk and Westchester Counties. Upstate includes all other counties | ||||||||||||
| (2) Rates only apply to impacted Adult Home class members | ||||||||||||
| *** Pending State and Federal Approval. | ||||||||||||
| The HARP BH HCBS Services Matrix and Fee Schedule can be found on the Office of Mental Health (OMH)'s Billing Behavioral Health (BH) Medicaid Services Under Managed Care, under: BH Rate Updates and Requirements (see: Medicaid Reimbursement Rates - Approved Medicaid fee-for-service rates for all OMH programs) at: https://omh.ny.gov/omhweb/bho/billing-services.html | ||||||||||||
Updated: May 2025
