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Fidelis Care received notice from New York State Office of Addiction Services and Support (OASAS), that providers are required to bill OTP bundle services under the APG methodology effective November 3, 2025. This applies to Medicaid Managed Care (MMC) plans, including Mainstream MMC plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs).

Initiative Timeline:

• Beginning July 1, 2024, providers were given the option to bill OTP bundle services either under the existing OTP bundle rate codes or the APG methodology.  The May memorandum also indicated that OASAS would zero out the bundle rate codes (7969-7976) after a short transition period.
• As of November 4, 2024, all OASAS programs were expected to exclusively bill OTP bundle services under the APG methodology using procedure codes G2067, G2068, G2078 and G2079. 
  • Providers may choose to bill other relevant APG procedure codes (e.g., H0020, 90834, etc.) instead of the bundle procedure codes.
  • Within the APG methodology, providers may switch between using the bundled and unbundled billing approaches as often as weekly, based on their preference.
• As most providers and plans have now updated their systems to accommodate OTP bundle billing through the APG methodology, OASAS will officially zero out OTP bundle rate codes 7969-7976 effective November 3, 2025.

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.