MedicaidBilling CodesMedium impact
NYS Medicaid FFS Billing
NY Medicaid·NY · Gastroenterology, Family Medicine, Internal Medicine·Claims & Billing
Effective date
Jan 1, 2026
We identified it
May 10, 2026
Summary
NYS Medicaid updated billing guidance for Patient Centered Medical Homes and coverage criteria for wireless capsule endoscopy, adding new CPT codes 91110 and 91111 for digestive tract imaging procedures. The policy also reinforces that only prescribers or their authorized agents may submit prior authorization requests.
Action Required
Immediately: Review and implement updated NYS PCMH billing guidance at health.ny.gov for recognized PCMH providers. Add CPT codes 91110 and 91111 to billing system for wireless capsule endoscopy procedures performed by Medicaid-enrolled gastroenterologists using FDA-cleared devices. Ensure only prescribers or their authorized agents submit prior authorization requests - third party PA requests are prohibited and risk program termination.