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Home Resources Medicaid Billing for OASAS Services

Medicaid CD Services and Corresponding Fees, Rates and Billing Codes

Service Article 28 (Department of Health) Article 32 (OASAS)
Rate Code D&TC Clinic Fee/Rate* Hospital Rate/Fee* Rate Code Upstate 1 Rate/Fee Downstate 2
Rate/Fee
Crisis Services
Medically Managed Withdrawal - 4800 Hospital Specific Per Diem N/A N/A N/A
MSIW w/o OBS days 4801 Hospital Specific Per Diem N/A N/A N/A
MSIW w/ one OBS days 4802 Hospital Specific Per Diem N/A N/A N/A
MSIW w/ two OBS days 4803 Hospital Specific Per Diem N/A N/A N/A
Medically Supervised Inpatient Withdrawal (MSIW) n/a N/A 4220 $286.53
[Operating Fee3] 		$357.78
[Operating Fee3]

Medically Supervised Outpatient Withdrawal (MSOW)

New Information The MSOW fee has been updated retroactive to 12/1/2009. The fees indicated on this table reflect the updated amount.

4279 Threshold Visit Rate Hospital Clinic Rate 4221 $200.62
(per visit)		 $220.67
(per visit)
Chemical Dependence Inpatient Rehabilitation
Chemical Dependence Inpatient Rehabilitation N/A N/A N/A 4204 Cost Based Per Diem Rate
Chemical Dependence Inpatient Rehabilitation, State Operated Addiction Treatment Center N/A N/A N/A 4202 Statewide Per Diem Fee
$273.82
Chemical Dependence Inpatient Rehabilitation 2957 N/A Cost Based Per Diem Rate 4213 Cost Based Per Diem Rate
Chemical Dependence Residential Rehabilitation Services for Youth (RRSY)
Bed Capacity 10-14 N/A N/A N/A 4210

$349.69

[Operating Fee4]

$394.96

[Operating Fee4]

Bed Capacity 15-39 N/A N/A N/A 4210

$266.58

[Operating Fee4]

$299.81

[Operating Fee4]

Bed Capacity 40-89 N/A N/A N/A 4210

$174.75

[Operating Fee4]

$194.65

[Operating Fee4]

Bed Capacity 90 or More N/A N/A N/A 4210

$151.07

[Operating Fee4]

$167.22

[Operating Fee4]

Chemical Dependence Medically Supervised Outpatient Clinic
Rate codes for Outpatient Clinic APG Billing are below. Note all claims must include the four digit rate code PLUS the appropriate service specific CPT or HCPCS code as discussed in APG Manual.
Assessment Visit, at least 30 minutes 4273 Threshold Visit Rate Hospital Clinic Rate 4214 Low-$102.76
Norm-$64.49
High-$62.00

(volume based per visit fee5)		 Low-$127.27
Norm-$77.03
High-$72.37

(volume based
per visit fee5)
Individual Session, at least 30 minutes 4274 Threshold Visit Rate Hospital Clinic Rate 4215
Group Session, at least 30 minutes

4275

Threshold Visit Rate

Hospital Clinic Rate

4216

Chemical Dependence Medically Supervised Outpatient Rehabilitation
Rate codes for Outpatient Clinic Rehab APG Billing are below. Note all claims must include the four digit rate code PLUS the appropriate service specific CPT or HCPCS code as discussed in APG Manual.
Assessment Visit, at least 30 minutes 4276 Threshold Visit Rate Hospital Clinic Rate 4217 $73.67
(per visit fee)		 $87.71
(per visit fee)
Full Day Rehab Visit, at least 4 hours in duration 4277 Threshold Visit Rate Hospital Clinic Rate 4218 $73.67
(per visit fee)		 $87.71
(per visit fee)
Half Day Rehab Visit, less than 4 hours but at least 2 hours in duration 4278 Threshold Visit Rate Hospital Clinic Rate 4219 $64.49
(per visit fee)		 $77.03
(per visit fee)
Chemical Dependency for Youth Outpatient Clinic
Rate codes for Outpatient Clinic Rehab APG Billing are below. Note all claims must include the four digit rate code PLUS the appropriate service specific CPT or HCPCS code as discussed in APG Manual.
Assessment Visit, at least 30 minutes 4283 Threshold Visit Rate Hospital Clinic Rate 4280 Low-$102.76
Norm-$64.49
High-$62.00

(volume based per visit fee5)		 Low-$127.27
Norm-$77.03
High-$72.37

(volume based
per visit fee5)
Individual Session, at least 30 minutes 4284 Threshold Visit Rate Hospital Clinic Rate 4281
Group Session, at least 30 minutes 4285 Threshold Visit Rate Hospital Clinic Rate 4282
Chemotherapy Substance Abuse Programs
Methadone Treatment Program (MTP) 1671 $138.00 (weekly Fee) N/A N/A N/A
Methadone Treatment Program (MTP) 2973 N/A $138.00 (weekly Fee) N/A N/A
MTP – Art 33 Physician Services, procedure code H0020, weekly fee $59.15
Buprenorphine Treatment in a Methadone Program 2531 Low Dose 2-10mg

$170.78

(Weekly Fee)

 N/A
Buprenorphine Treatment in a Methadone Program 2532 Medium Dose 12-20mg

$200.44

(Weekly Fee)
Buprenorphine Treatment in a Methadone Program 2533 High Dose-22-26 mgs

$230.11

(Weekly Fee)
Buprenorphine Treatment in a Methadone Program 2534 Max. Dose-28+mgs

$259.78

(Weekly Fee)

1Upstate: Any county not included in the downstate grouping.
2Downstate: Rockland County, Putman County, Westchester County, New York County, Kings County, Queens County, Bronx County, Richmond County, Nassau County, Suffolk County.
3 MSIW Operating Fee: The operating fee includes all relevant programmatic expenses. In addition to the operating fee OASAS certified MSIW programs also receive a provider specific capital add-on fee to address OASAS-approved capital costs.
4 RRSY Operating Fee: The operating fee includes all relevant programmatic expenses, including routine medical and necessary psychiatric / psychological services. In addition to the operating fee OASAS certified RRSY programs also receive a provider specific capital add-on fee to address OASAS-approved capital costs.
5Specific volume based fee assigned pursuant to local services bulletin 2005-03
* Article 28 rates, with the exception of methadone fees, vary by provider and in the case of the outpatient rates are subject to statutory caps. Contact the New York State Department of Health at Bureau of Health Economics (518) 473-8822 for more information.