Additional Enhanced Rates for Evidence Based Practices (EBPs) within Children and Family Treatment and Support Services (CFTSS)
IMPACTED PLANS: Medicaid, HIV, SNP, AND CHILD HEALTH PLUS
TO: Children and Family Treatment Support Services (CFTSS) Provider Agencies
- (Retro) Effective January 1, 2025, the New York State (NYS) Department of Health implemented a new Evidence-Based Practice (EBP) and has authorized a selected number of qualified CFTSS providers who can bill for new EBP rates. Only State authorized CFTSS agencies that provide Other Licensed Practitioner (OLP) and Community Psychiatric Supports and Treatment (CPST), are eligible to offer the new EBP, Multidimensional Family Therapy (MDFT), as an additional allowable model.
(Retro) Effective for Dates of Service, January 1, 2025, onwards, MetroPlusHealth will cover and reimburse claims billed with the two new rate codes in combination with the corresponding Procedure Code and Modifiers, as applicable, shown in the table below:
| Service Description | Rate Code | Procedure Code | Modifiers | Billing Unit | Unit Limits |
|---|---|---|---|---|---|
| OLP Counseling (Individual and/or Family), Evidence Based Practice, MDFT | 7984 | H0004 | U1, UA | 15 minutes | N/A |
| CPST Service Professional (Individual and/or Family) | 7985 | H0036 | U1, UA | 15 minutes | N/A |
| Evidence Based Practice, MDFT |
Note: There is no EBP-specific off-site rate code for these services, the standard code still applies.
Reminder: There are no unit limits (i.e., annual, daily, dollar amount) for CFTSS. All determinations of scope, frequency and duration must be in accordance with medical necessity and an individualized treatment plan.
For additional billing and policy details regarding EBPs, please refer to the July 2025 New York State Medicaid Update and the CFTSS Manual.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].