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

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

UPDATE

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

UPDATE: Information highlighted in this announcement reflects updates or changes that are new as of September 22, 2025.

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

Date: September 22, 2025.

Effective January 1, 2025, New York State (State) implemented a new evidence-based practice (EBP). The State has authorized 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 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 (FFT) 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 began in January 2025; the initial cohort for MDFT began in July 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 MMCPs. NYS has obtained approval of the State Plan Amendment from the Centers for Medicare and Medicaid Services (CMS) to implement this update. MMCPs are required to configure their systems to accept and process the new EBP billing codes and rates no later than 90 days from the date of this announcement. 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.

Service Description	Rate Code	Procedure Code	Modifier	Billingh Unit Measure	Unit Limit**	Rates Upstate	Rates Downstate
Other Licensed Practitioner (OLP) Counseling Individual and/or Family, EBP, 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

**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.

For additional billing and policy detail regarding EBPs, refer to the July 2025 New York State Medicaid Update and the CFTSS Manual.

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