Medicaid in Education Alert
New York State Department of Health (DOH), Office of Health Insurance Programs (OHIP)
New York State Education Department (NYSED)
Preschool/School Supportive Health Services Program (SSHSP)
Medicaid in Education

Issue #18-01

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP &
NYSED Medicaid in Education Unit
Date: January 16, 2018
Subject: Updated Handout 5 SSHSP Billing Codes

The purpose of this Alert is to notify SSHSP providers that the SSHSP Current Procedural Terminology (CPT) Codes (also known as Handout 5) have been updated and must be used for Medicaid billing of SSHSP services rendered on and after January 1, 2018.  Each enrolled SSHSP billing provider should have received correspondence from the NYS Department of Health (DOH) indicating that new billing codes have been added to their Medicaid enrollment file.  If you have not received this confirmation, please contact DOH at (518) 473-2160 or at SSHSP@health.ny.gov.

Handout 5 now includes the expanded physical and occupational therapy evaluation codes that were announced in Medicaid Alert 17-05.  Other CPT code descriptions have also been modified in compliance by the American Medical Association (AMA).  These CPT codes have been updated on Handout 5:

CPT codes 97161-97164 (Physical Therapy Evaluations/Reevaluation)

  • 97161 - 97164 replaced 97001 and 97002.  The three new evaluation codes for physical therapy reflect levels of patient presentation: low-complexity, moderate-complexity, and high-complexity.

CPT codes 97165-97168 (Occupational Therapy Evaluations/Reevaluation)

  • 97165 - 97168 replaced 97003 and 97004.  The three new evaluation codes for occupational therapy reflect levels of patient presentation: low-complexity, moderate-complexity, and high-complexity.

CPT codes 97760 - 97763 (Occupational/Physical Therapy Orthotic/Prosthetic Management)

  • Codes use to report orthotic and prosthetic management and training services have been revised by differentiating between initial and subsequent encounters through the: addition of the term “initial encounter” to the code descriptors for CPT codes 97760 and 97761, creation of CPT code 97763 to describe all subsequent encounters for orthotics and/or prosthetics management and training services, and deletion of CPT code 97762.  The new long descriptors for CPT codes 97760 and 97761 – now intended only to be reported for the initial encounter with the patient – are:

  • 97760 (Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes)

  • 97761 (Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes)

CPT codes 90832 – 90838 (Psychological Counseling)

  • Service descriptions for these psychotherapy codes were revised to remove the words “and/or family member” in compliance with changes made by the American Medical Association (AMA). 

The new Handout 5 is attached to this Alert and is also available online at: http://www.oms.nysed.gov/medicaid/training_materials/.

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov or the NYS Education Department, Medicaid Unit at medined@nysed.gov.

Last Updated: January 16, 2018