NYS Medicaid Update for Child Abuse Pediatrics Reimbursement and ABP Certification Requirement
Impacted LOBs: Medicaid and HIV-SNP Plans
TO: All Providers
Dear Valued MetroPlusHealth Provider,
Per New York State Medicaid Update, effective since December 1, 2025, MetroPlusHealth will reimburse physicians certified by the American Board of Pediatrics (ABP) in Child Abuse Pediatrics when billed for a once-per-member per lifetime service provided for the diagnosis and treatment of suspected child maltreatment. This one-time service is billable when provided directly by an ABP certified Child Abuse Pediatrician. This service is also billable when an ABP certified Child Abuse Pediatrician is supervising a physician, nurse practitioner (NP), or physician assistant (PA) providing direct care in a child abuse case.
Billing Codes and ABP Certification Requirement
To comply with the NYS Medicaid mandate effective December 1, 2025, for Medicaid Managed Care and HIV Special Needs Plans, physicians billing for this service must be certified by the ABP in Child Abuse Pediatrics and enrolled with the appropriate specialty designation.
- ABP Certified physicians with specialty code “168” (Child Abuse Pediatric Specialty), may submit a claim for this once/member/lifetime service billed with CPT code “G9012”
- CPT code “G9012” may be billed in addition to an Evaluation and Management (E&M) visit on the same date of service.
- When submitting a claim for supervision of a physician, NP or PA, append modifiers “U2” and “U2” to CPT code “G9012”.
To avoid claim processing delays, providers should proactively submit proof of documentation to verify active ABP certification in Child Abuse Pediatrics to the Provider Relations e-mail address – [email protected]. Please reference ABP Certification in Child Abuse Pediatrics in the subject line of your email for tracking purposes. This proof of documentation is required even if claims have been submitted electronically.
We appreciate your continued cooperation and commitment to our members. If you have any questions regarding this notice or proof of ABP certification requirements, please contact MetroPlusHealth at 800.303.9626.