Notification Regarding Enhanced Rates for Evidence Based Practices (EBPs) within Children and Family Treatment and Support Services (CFTSS)

  • Notice is also available in Portable Document Format (PDF)

To:   Medicaid Managed Care Plans (MMCPs), including Mainstream Managed Care and HIV
        Special Needs Plans and Children and Family Treatment Support Services (CFTSS) Providers

Date: February 24, 2025

Effective January 1, 2025, New York State implemented a new evidence-based practice (EBP), pending State Plan Amendment (SPA) approval from Centers for Medicare and Medicaid Services (CMS). The State will authorize a selected number of qualified CFTSS providers to receive EBP training and bill for new EBP rates. The State is committed to the promotion and support of EBPs, specific research supported psychotherapeutic interventions with demonstrated outcomes, within Children and Family Treatment and Support Services (CFTSS).

CFTSS designated agencies that provide Other Licensed Practitioner (OLP), and Community Psychiatric Supports and Treatment (CPST) will be able to offer EBPs through an authorization process. Agencies must apply and receive authorization from the NYS EBP Review Team. The State will only issue authorization to agencies with OLP and CPST designation, even though individual practitioners or teams in that agency will be credentialed in an EBP. Authorization will not be granted to individuals or groups. It is the responsibility of the EBP authorized agency to ensure they maintain fidelity to the EBP model. The State had previously implemented Functional Family Therapy (FFP) and Parent Child Interaction Therapy (PCIT) EBPs, and has identified a third EBP, Multi-Dimensional Family Therapy (MDFT) as an additional allowable model. Authorization for the State endorsed EBPs occurs in cohorts to align with training. A second cohort for FFT and PCIT is anticipated to begin in January 2025; the initial cohort for MDFT is anticipated in Spring 2025.

After providers receive EBP authorization from the State and begin the required training, they will be allowed to bill the new EBP service rate codes. These new rate codes supplant existing rate codes for CPST or OLP when EBP services are provided*. Providers submit the same type of rate code claim for individual sessions and family sessions. The rate and procedure code numbers apply to both OLP family and individual sessions. The State will provide MMCPs with the list of authorized agencies for EBP (either through Exhibit 4 or via a separate list) to support MMCPs’ system configuration. EBPs in CFTSS will not require prior authorization from Plans. MMCPs will need to accept claims for EBPs provided by CFTSS providers retroactive for dates of services on or after January 1, 2025. MMCPs will need to provide guidance to CFTSS EBP providers on when and how to effectively submit claims for previously rendered EBPs.

*While authorized providers bill the EBP rate code for corresponding services per the below grid, when the service is delivered off-site, the service off-site rate code is also billed. There is no EBP-specific off-site rate code for these services, the standard code still applies.

Note: There are no unit limits (i.e., annual, daily, dollar amount) for CFTSS. All determinations of scope, frequency and duration must be in accordance with medical necessity and an individualized treatment plan.

Service Description Rate Code Procedure Code Modifier Billing Unit Measure Unit Limit Pending Approval Rates Upstate** Pending Approval Rates Downstate**
Other Licensed Practitioner (OLP) Counseling Individual and/or Family, EPB, MDFT 7984 H0004 U1, UA 15 minutes N/A 78.72 88.26
Community Psychiatric Supports and Treatment (CPST) Service Professional, Individual and/or Family, EBP, MDFT 7985 H0036 U1, UA 15 minutes N/A 50.56 56.74

**Rates are draft, pending approval of the State Plan Amendment by CMS. The State anticipates receiving CMS approval in early 2025 for the State Plan Amendment, which has a targeted effective date of January 1, 2025.

The CFTSS provider guidance for EBPs can be found here.

If you have any questions, please reach out to DOH at BH.Transition@health.ny.gov.