Behavioral HealthMedicaidDecember 5, 2023

HCBS and CFTSS billing changes

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective December 1, 2023, New York State is implementing a billing change that will allow claims for Children’s Home and Community Based Services (HCBS) and Children and Family Treatment Support Services (CFTSS) to be paid based on the county in which services were provided, rather than a provider’s corporate headquarters or central office address. This update is necessary to align with the Centers for Medicare and Medicaid Services (CMS) billing requirements, which dictate that services must be reimbursed based on the location of service delivery.

The billing requirements will apply to both Medicaid Managed Care and Child Health Plus.

The State has assigned a Federal Information Processing Standards (FIPS) code and a proxy locator code to each county in New York State. The applicable FIPS (if submitting electronically) or proxy locator (if submitting on paper) county code, indicating service location, must be included on all Children’s HCBS, and CFTSS claims submitted for dates of service on or after December 1, 2023. The county FIPS and proxy locator codes are as follows:

  • Link to FIPS code locator guide: FIPS Code locator
  • For electronic claims:
    • Value code 24 and the rate code are to be entered in field 39A; the rate code is input into the amount field. Value code 85 and the FIPS code are to be entered in field 40A; the 5-digit FIPS codes is input into the amount field.
  • Disclaimer for paper claims:
    • Value code 24 and the rate code are to be entered in field 39A. The rate code is input into the amount field. Value code 61 and the count locator code are to be entered in field 40A.

Claims for HCBS and CFTSS services billed without the FIPS and value code requirements will be denied for dates of service on or after December 1, 2023.

HCBS and CFTSS providers must be designated to provide services within a specific county to bill for services.

Health Home claims for Palliative Care – Counseling and Support Services, Bereavement – Assessment/Counseling and all Health Home Bereavement services must include the appropriate FIPS/county locator code.

For telehealth services, the county code included on the claim should be the county where the member was located during the service.

Link to New York State Guidance.

Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association.

NYBCBS-CD-045152-23