Mar 12, 2026
New York State
Department of Health
Bureau of Early Intervention (BEI) Electronic Mailing List
Early Intervention 4% Rate Modifier – Medicaid Implementation
Dear
Colleague:
The New York State Department of Health (Department) Bureau of
Early Intervention is pleased to announce that the Office of Health Insurance
Programs (OHIP) has implemented the Early Intervention 4% rate modifier in
eMedNY. Provider claims that are eligible for the 4% rate increase for children with Medicaid coverage will
be submitted to Medicaid starting March 16, 2026. Providers’ claims that are
accepted in the EI-HUB by March 18 will be paid in Medicaid cycle 2535 and paid
on March 25 for providers off the lag and on April 8 for providers on the lag.
PCG will resubmit all claims paid by Medicaid for dates of service
retroactive to April 1, 2025, that are eligible for the 4% rate modifier to
Medicaid during the week of March 30. Retroactive 4% payments will be made in
Medicaid cycle 2537 and paid on April 8 for providers off the lag and on April
22 for providers on the lag.
The 4% rate modifier is applied to core in-person EI services that
are provided to children who reside in rural and underserved areas of New York
State that meet certain criteria. The following core services are eligible for
the 4% rate modifier: screenings, multidisciplinary evaluations (MDEs),
bilingual add-ons, and speech therapy, occupational therapy, physical therapy
and special instruction services authorized as Basic Home and Community visits.
Telehealth services are not eligible for the modifier.
Counties and providers do not have to take any additional action
in the data system (EI-Hub), e.g., service authorizations or claim code. The
EI-HUB will apply the 4% rate modifier based on the service type and child’s
residential zip code.
If you have any questions regarding this notice, please contact
the Bureau of Early Intervention at EIP.Fiscal@health.ny.gov or by phone at (518)
473-7016.