December 1, 2025Attention: 2026 NYS MEDICAID DENTAL POLICY AND PROCEDURE CODE MANUAL AND UPDATED FEE SCHEDULE
The 2026 Dental Policy and Procedure Codes Manual and Fee Schedule have been posted. Changes reflected in the manual are effective for dates of service beginning January 1, 2026. Questions related to manual and fee schedule updates can be directed to the Bureau of Dental Review at dentalpolicy@health.ny.gov, or (800) 342-3005, Option 2. Billing related questions can be directed to GDIT at (800) 343-9000.
Click Here for the Dental Manual Page
- November 26, 2025
Attention: Backup Power Wheelchair Repairs
Effective January 1, 2026 for Fee-for-Service (FFS) and March 1, 2026 for Managed Care, in limited instances, Group 2, Group 3, Group 4, Group 5, and Group 6 power wheelchairs (PWC) with or without power options, will be eligible for use as a backup power wheelchair when the user has been provided with a new, primary PWC. This backup PWC will allow the member to maintain independent mobility when the primary PWC is being repaired or when a backup manual wheelchair or suitable loaner wheelchair that would meet the member’s medical needs cannot be provided.
Please see communication for additional information.
- November 26, 2025
Attention: Preventative Maintenance for Power Wheelchairs
Effective January 1, 2026 for Fee-for-Service (FFS), and March 1, 2026 for Managed Care, preventative maintenance will be covered for all primary power wheelchairs (PWC) that are less than 5 years old.
Please see communication for additional information.
- October 24, 2025
Attention: Effective November 3, 2025, Clinic Claims setting Edit 02166 will pend to the Department of Health for manual review
Effective November 3, 2025, Clinic claims setting edit 02166 – Delay reason code 11 invalid will pend to the Department of Health (DOH) for manual review. The corresponding HIPAA codes that will be reported on the 835 remittances are Claim Adjustment Reason Code 29 and Remittance Remark Code N892. While the claim(s) is pending review, the corresponding claim status response code will be 718.
Please see communication for additional information.
- September 3, 2025
Attention: The 2025 DME Policy Guidelines, the DME Procedure Codes, the Medical Supply Procedure Codes & Coverage Guidelines manual, and DMEPOS Fee Schedule have been updated.
Any changes reflected in the manuals are effective for dates of service beginning October 1, 2025. Questions related to coverage criteria and guidelines can be directed to the Office of Health Insurance Programs at OHIPMedPA@health.ny.gov. Pharmacy coverage questions can be directed to NYRx@health.ny.gov. Billing related questions can be directed to GDIT at (800) 343-9000.
Click Here for the DME Manual Page
- August 29, 2025
Attention: The Policy Guidelines for Private Duty Nursing (PDN) has been Updated for October 2025
The Private Duty Nursing Policy Manual has been updated for October 2025. Updates include language modifications for Section 9.6 Increase of Hours, and Section 11.5 Travel Away from Home.
Click here for more details.
- August 28, 2025
Attention: The Hearing Aid Fee Schedule and the Hearing Aid Procedure Code Manuals have been updated for 10/1/2025
Please note, the fee schedule and procedure codes for the Hearing Aid manual have been updated for October 1, 2025. Any changes reflected in the manual are effective for dates of service beginning October 1, 2025. Questions related to policy or coverage guidelines can be directed to the Office of Health Insurance Program's Division of Operations and Systems at OHIPMedPA@health.ny.gov. Billing related questions can be directed to GDIT at (800) 343-9000.
Click here for the Hearing Aid Manual page
Complete the EFT Form
