¡Bienvenidos, proveedores!

New York CMS Cell Gene Therapy Access Model Update The New York State (NYS) Department of Health has applied to participate in the federal Centers for Medicare and Medicaid Services (CMS) Cell and Gene Therapy (CGT) Access model. The model is voluntary for State Medicaid programs and manufacturers and will test whether a CMS-led approach to developing outcomes-based agreements (OBAs) for cell and gene therapies increases Medicaid beneficiaries’ access to innovative treatment, improve health outcomes, and reduces health care costs to State Medicaid programs. The initial focus of the model is on gene therapies for people living with sickle cell disease,

Fidelis Care would like to inform providers that evaluation and management (E&M) services billed on a facility claim with treatment room revenue codes are not eligible for reimbursement.  Evaluation and Management procedure codes represent the professional service – the physician or qualified provider’s time, assessment and decision- making. Treatment room revenue codes (760, 761 and 769) represent the facility charge for use of space, supplies, and staff for treatment or observation of a patient. Treatment rooms are typically used when a therapeutic or diagnostic procedure (e.g., an infusion, injection wound care) is performed, not when the visit consists primarily of evaluation

Fidelis Care is pleased to announce the release of our 2025 Community Impact Report, a comprehensive look at how we worked together to make a difference in communities across New York State. The report reflects our shared commitment to health equity, access, and whole-person care. These values guide every interaction with our members and every partnership with providers like you. From expanding preventive services to addressing health-related social needs, the report showcases how collaboration drives meaningful change.   The report details initiatives that directly impact your work and your patients, including nearly $650,000 in Health Equity Grants, expanded StreetSide RV outreach, and

The following sections of the Fidelis Care authorization grids have been updated effective March 1, 2026.             The following codes have been added to the Medicaid, Medicare, Essential Plan, and Qualified Health Plan Authorization Grids and require prior authorization: III.       Outpatient surgery: The following services require prior authorization:                   D.  Skin surgery and other dermatological procedures:                        · Only the following codes continue to require authorization for any place of service: Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4420, Q4431, Q4432, Q4433                    K.  Vascular procedures