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Provides an open list of CPT and HCPCS codes, plus billing, coding, and documentation guidelines, along with key requirements affecting which services can be billed. 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HealthySteps sites can bill Medicaid and Medicaid Managed Care carriers for some of the services they provide to children and families.  \nThis document provides a list of open Current Procedural Terminology (CPT) 1 and Healthcare Common Procedure Coding System (HCPCS)2 codes, with applicable billing, coding, and documentation guidelines.  \nThere are a variety of requirements and restrictions that can impact your practice’s ability to bill specific codes, including the provider type, location of service, frequency, and maximum billing units. This document aims to facilitate an understanding of these requirements and restrictions and help guide your practice in coding and billing for HealthySteps services.  \nTo maximize appropriate reimbursement, we recommend always contacting health insurance carriers for verification on billing for services provided.  \n1 Current Procedural Terminology (CPT) is a medical code set that is used to report and bill for medical, surgical, and diagnostic services.  \n2 The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes used to report and bill for medical services, supplies, and procedures  \nDisclaimer: This document is not intended to give billing advice or guidance to any specific provider or HealthySteps site and does not consider the fact that payors, providers, and sites may have their own policies and procedures that may affect or prohibit implementation of these recommendations. Additionally, billing guidance is updated often. If there are any updates you recommend, please reach out to [HSPolicyandFinance@zerotothree.org](HSPolicyandFinance@zerotothree.org).  \nTable of Contents  \nWhat is the Prospective Payment System (P PS)?.....................................................................................................................3  \nApplicable CMS Guidelines………………………………………………………………………………………………………………………………………………..4  \nNew York State Medicaid Reimbursable Clinicians Rendering HealthySteps-Aligned Services………..................................4  \nUse of Medical Coding Modifiers Applicable to HealthySteps-Aligned Services/ Reporting of Units.................................5  \nServices Rendered by Social Workers…………………………………………………………………………………………………………………………….6  \nHealthySteps-Aligned Services………………………………………………………………………………………………………..………………………………..8  \nChild Developmental, Social-Emotional Screenings…………………………………………………………………….….................................8  \nScreening for Depression……………………………………………………………………………………………………………….................................9  \nScreening for Adverse Childhood Experiences (ACEs)…………………………………………………………………………………………………..10  \nHealth and Behavior Assessment/Re-assessment/Intervention with/without the Family Present………………………………. 11  \nCare Management: General Behavioral Health Intervention…………………………………………………………………………………………13  \nPsychiatric Diagnostic Evaluation………………………………………………………………………………………………..………………………………..14  \nPsychological, Neuropsychological, Developmental Test Administrations and Evaluations…………………………………………..15  \nInteractive Complexity………………………………………….……………………………………………………………………..................................18  \nPsychotherapy……………………………………………………………………………………………………………………………………………………………..20  \nHealth and Behavior Assessment, Re-assessment/Individual Intervention…………………………………………………………………..24  \nScreening, Brief Intervention, and Referral to Treatment (SBIRT) Services…………………………………………………………………..25  \nSmoking Cessation……………………………………………………………………………………………………………………………………………………....27  \nLactation Services………………………………………………………………………………………………………………………………………………………..28  \nVirtual Comm","cbCaifcW1nv4KTHh","https://ap.wps.com/l/cbCaifcW1nv4KTHh","pdf",761326,39,"English","# What is the Prospective Payment System (PPS)?\n# Applicable CMS Guidelines\n# New York State Medicaid Reimbursable Clinicians Rendering HealthySteps-Aligned Services\n# Use of Medical Coding Modifiers Applicable to HealthySteps-Aligned Services/ Reporting of Units\n# Services Rendered by Social Workers\n# HealthySteps-Aligned Services\n## Child Developmental, Social-Emotional Screenings\n## Screening for Depression\n## Screening for Adverse Childhood Experiences (ACEs)\n## Health and Behavior Assessment/Re-assessment/Intervention with/without the Family Present\n## Care Management: General Behavioral Health Intervention\n## Psychiatric Diagnostic Evaluation\n## Psychological, Neuropsychological, Developmental Test Administrations and Evaluations\n## Interactive Complexity\n## Psychotherapy\n## Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services\n## Smoking Cessation\n## Lactation Services\n## Virtual Communication\n## Telephone Assessment and Management Services\n## eVisits\n## Community Health Worker Services\n# Sources","[{\"question\":\"What is the Prospective Payment System (PPS) in New York Medicaid billing?\",\"answer\":\"PPS assigns a fixed payment rate to reimbursable treatments, with the provider receiving the same payment amount for a specific treatment regardless of service intensity.\"},{\"question\":\"Which coding and billing elements does the guide include for HealthySteps-aligned services?\",\"answer\":\"The guide lists applicable CPT and HCPCS codes and provides billing, coding, and documentation guidelines, including requirements and restrictions that affect eligibility for specific codes.\"},{\"question\":\"What factors can impact whether a HealthySteps site can bill a specific code?\",\"answer\":\"The guide notes restrictions related to provider type, location of service, frequency, and maximum billing units, which can affect a practice’s ability to bill specific codes.\"}]","New York State - HealthySteps PPS Billing and Coding Guide - Updated January 2026 | PDF",1789992115,98]