MedicaidBilling CodesMedium impact
Updates to Fee Schedules for Physician, Nurse Practitioner and Midwife Services
NY Medicaid·NY · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
May 24, 2026
Summary
New York State Medicaid is updating fee schedules for physician, nurse practitioner, and midwife services. For obstetric care, providers must use E/M CPT codes with TH modifier and include Category II CPT code 0500F for initial prenatal visits for patients initiating care on/after June 1, 2026.
Action Required
By June 1, 2026: Billing team must update obstetric billing procedures to use E/M CPT codes with TH modifier for prenatal visits, add pregnancy-related O or Z ICD-10 diagnostic codes for all prenatal visits, and include Category II CPT code 0500F for all initial prenatal visits for patients initiating care on/after June 1, 2026. Update billing system rules and encounter forms accordingly.