NY Medicaid Telehealth Billing for Therapists
By George Ruan • October 9, 2026
Start with the official NYSDOH telehealth policy page and the current Telehealth Policy Manual, version 2026-V2, updated July 2026 and effective July 29, 2026. This therapist billing guide was checked October 9, 2026. Identify the payer, service setting and modality before choosing a modifier or place of service.
Sections
Identify which telehealth policy applies
The state telehealth page covers Medicaid FFS and managed care, while recognizing separate OMH, OASAS and OPWDD guidance. An ordinary private-practice professional claim and a service in an agency-authorized program can have different instructions. Use the requirements for the program actually delivering the service.
Check service-date eligibility and the responsible behavioral health payer. For managed care, the manual's section 9.19 directs reimbursement and documentation questions to the plan and allows additional plan claim requirements. Do not automatically carry an FFS claim setup into every HARP or Medicaid managed-care product.
Audio-video modifiers: 95 or GT
The general FFS guidance recognizes 95 or GT for audio-video services, subject to the applicable program's instructions. Select the modifier required for the actual service and payer. Adding a telehealth modifier does not establish that an otherwise unsupported procedure code is payable for your profession.
Use the profession-specific claims guide to find the current code schedule and billing references. Document the service delivered and the modality used rather than choosing a modifier solely because the appointment was scheduled as virtual.
Audio-only conditions and modifiers
The manual recognizes 93 or FQ in its general audio-only guidance, with program-specific requirements. Audio-only coverage requires the listed conditions, including unavailable audio-video equipment or connectivity, the member's preference for audio-only, availability of audio-video or in-person care on request, clinical effectiveness without visual information, and documentation supporting the code's requirements. Provider convenience alone does not meet that standard.
For OMH-licensed, designated or authorized providers, the OMH modifier memo requires 93 for eligible audio-only services effective July 1, 2025, and removes FQ from the OMH grid. That instruction is specific to the OMH billing context; it does not mean FQ is forbidden in every New York Medicaid scenario.
POS 02, 10 and the New York POS 11 exception
The manual's section 9.3 describes POS 02 when the patient is somewhere other than home and POS 10 when the patient is at home. It also includes an office exception that matters for private-practice professional claims: providers who would report POS 11 for an in-person office visit should report POS 11 for telehealth to obtain the appropriate reimbursement.
The manual says POS 02 and 10 remain allowable. Do not apply a blanket rule that every home-based session must use POS 10 without reviewing this state instruction and the responsible plan or program's rules. Record the patient's location even when the applicable billing instruction calls for POS 11.
Document and review before submission
Use the current manual alongside the profession and program policy. We recommend a pre-billing review covering:
The covered service and procedure code for the actual enrolled profession.
Patient consent, the modality delivered, patient and provider locations, and the clinical service and time documentation.
The applicable audio-only conditions, if relevant, and how a connection failure or modality change was handled under current policy.
The modifier and POS required by the payer and program for that service.
Enrollment, network status and any applicable authorization for the service date.
The manual permits documented verbal consent; it does not make a universal signed telehealth form the only consent route. Keep the consent and clinical evidence with the service record. For the FFS submission steps, follow the ePACES batch and status workflow. For a plan-covered service, confirm the specific plan product and claim instructions before sending the claim.
Frequently Asked Questions
Does every New York Medicaid telehealth visit use POS 02 or 10?
No. The July 2026 manual also directs providers who would use POS 11 for an in-person office visit to report POS 11 for telehealth for appropriate reimbursement. Check the responsible plan or program’s requirements.
Is modifier FQ always wrong for New York Medicaid audio-only care?
No. General state guidance recognizes 93 or FQ, while OMH requires 93 for eligible audio-only services from July 1, 2025. Apply the instructions for the actual program and payer.
Can a therapist use audio-only just because it is convenient?
The manual lists coverage conditions involving technology availability, member preference, alternatives, clinical effectiveness and documentation. Provider convenience alone does not establish those conditions.
Sources
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