New York Medicaid Rates: Navigating eMedNY Fee Schedules

New York’s Medicaid program is administered by the NY State Department of Health, with fee schedules published through eMedNY — the state’s provider portal — organized as per-specialty provider manuals rather than one consolidated file.

What’s currently published

Current published rates tracked by MedicaidBench, with a 2026-07-01 effective date:

• 90791 (initial psychiatric diagnostic evaluation): $177.67 per encounter
• 90837 (individual psychotherapy, ~60 min): $161.13 per session
• 99213 (established-patient office visit): $21.76 per visit
• 99214 (moderate-complexity office visit): $34.03

The gap between New York’s behavioral health rates and its primary care E/M rates is notably wide compared to some other states — worth factoring in if you’re building a multi-state model that assumes a state’s behavioral health and primary care reimbursement move roughly in proportion to each other. In New York’s case, they clearly don’t.

Format and access

eMedNY’s per-specialty provider manual structure means the file you need depends on which specialty is billing the code — a behavioral health provider and a primary care provider looking up related codes may need entirely different manual sections, even for services that seem adjacent.

What to watch for

New York’s HCBS and behavioral health billing landscape has been an area of active state policy attention, given the state’s size and the volume of services delivered under its various waiver programs. If your organization operates across multiple New York programs, confirming which manual and rate applies to a given service line is worth double-checking rather than assuming one section covers everything.

Keeping current

Because eMedNY organizes rates by specialty manual rather than a single always-current master file, tracking a specific code’s history requires knowing which manual to watch — and re-checking it on some cadence, since there’s no unified changelog across manuals. MedicaidBench tracks New York’s fee schedule data continuously and normalizes it into one structure regardless of which manual a code originally came from.