MedicaidBilling CodesMedium impact
Submission of Secondary Claims to New York State Medicaid and Use of Claim Adjustment Reason Codes
NY Medicaid·NY · OB-GYN·Claims & Billing
Effective date
Jun 1, 2026
We identified it
May 24, 2026
Summary
New York State Medicaid now requires specific billing procedures for secondary claims and claim adjustment reason codes. For obstetric services, providers must use E/M CPT codes with TH modifier, pregnancy-related ICD-10 codes, and include Category II CPT code 0500F for initial prenatal visits when care initiates on/after June 1, 2026.
Action Required
By June 1, 2026: Obstetric providers must update billing workflows to use E/M CPT codes with TH modifier for all prenatal visits, ensure pregnancy-related O or Z ICD-10 diagnostic codes are used, and include Category II CPT code 0500F for all initial prenatal visits. Update billing system rules and encounter forms to reflect these requirements for patients initiating prenatal care on/after June 1, 2026 or with due dates on/after January 1, 2027.