Attachment G_Mobile Crisis Medicaid Reimbursement Rates_06.30.2025.xlsx
XLSX spreadsheet 1006 KB Posted
- Attached to
- Mobile Crisis Services State and local contract opportunity
- Solicitation number
- 2025-052
- Issued by
- Broome County, New York
About this file
This file is a comprehensive Medicaid reimbursement rate schedule for Mobile Crisis Services issued by New York State, effective 06.30.2025, covering crisis intervention services across downstate and upstate regions. The document outlines detailed rate codes for various mobile and telephonic crisis response services, including licensed and unlicensed provider interventions, with specific parameters for service duration, response types (one-person or two-person), and intervention modes such as telephonic crisis response, mobile crisis response, and crisis follow-up services.
The rate schedule provides granular pricing for different crisis intervention scenarios, with distinct rates for downstate and upstate counties. Downstate counties include New York City's five boroughs (Bronx, Kings, New York, Queens, and Richmond) and additional counties like Dutchess, Nassau, and Westchester. Rates range from $23.86 to $2,519.13 depending on service type, provider licensure, response complexity, and duration. The document notes that rates are subject to change and are pending approval from CMS and the Department of Budget. The rates apply to Medicaid reimbursement and are designed to support comprehensive mental health and substance use disorder crisis interventions across New York State.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment A_NYS Crisis Intervention Benefit_02.2025.pdf | ||
| Attachment B_SPA Updates to Mobile Crisis Services_02.01.2024.pdf | ||
| Attachment H_Attestations A-B-C-D_07.2025.pdf | ||
| Attachment F_Mobile Crisis Costing Model_OMH.CCSI_04.2025.xlsx | XLSX spreadsheet | |
| Attachment C_NYS OMH Mobile Crisis Program Guidance_09.20.2019.pdf | ||
| Attachment D_Mobile Crisis Guidelines for BC_07.2025.pdf | ||
| Attachment E_Mobile Crisis Budget Template_07.2025.xlsx | XLSX spreadsheet | |
| Attachment I_NYS OMH Telehealth Guidance_04.2023.pdf | ||
| Attachment J_RFP Evaluation Rubric_07.2025.pdf | ||
| RFP-2025-052 - Mobile Crisis Services.pdf |
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Text version
Mobile Crisis_update 06.30.2025
| Crisis Intervention - Mobile/Telephonic Crisis Calculated Rates | |||||||||
| *Regional Rates | |||||||||
| Note: Prior to 4/1/22 services below were only available via Medicaid Managed Care Organizations (MMCOs) to individuals 21 and older. | |||||||||
| ***Effective 04/01/2025 | |||||||||
| Rate code | Rate code description | Px code | Px code description | Modifier | Specialty code | Unit Type | Unit Limit | Downstate | Upstate |
| 4609 | Telephonic crisis response - Licensed (up to 90 min) | H2011 | Crisis Intervention service, per 15 min | GT | 824 | 15 min | 6 | $ 65.60 | $ 58.38 |
| 4610** | Telephonic crisis response (up to 90 min) - unlicensed | H2011 | Crisis Intervention service, per 15 min | GT, HO | 824 | 15 min | 6 | $ 39.36 | $ 35.03 |
| 4611 | Telephonic crisis response - Licensed (Above 90 min - 3 hours) | S9485 | Crisis Intervention service, per diem | GT | 824 | per diem | 1 | $ 590.42 | $ 525.47 |
| 4612** | Telephonic crisis response - unlicensed (Above 90 min - 3 hours) | S9485 | Crisis Intervention service, per diem | HO | 824 | per diem | 1 | $ 354.25 | $ 315.28 |
| 4613 | Telephonic Crisis follow up - Licensed | H2011 | Crisis intervention service, per 15 minutes | TS, GT | 824 | 15 min | 4 | $ 58.31 | $ 51.90 |
| 4614 | Telephonic Crisis follow up - Unlicensed/Certified Peer | H2011 | Crisis intervention service, per 15 minutes | TS, HM | 824 | 15 min | 4 | $ 23.86 | $ 21.24 |
| 4615 | Mobile crisis response - one person response, Licensed - up to 90 min | H2011 | Crisis Intervention service, per 15 min | HE | 824 | 15 min | 6 | $ 104.96 | $ 93.41 |
| 4616 | Mobile crisis response - two person response - Licensed and Unlicensed/Certified Peer- up to 90 minutes | H2011 | Crisis Intervention service, per 15 min | HK | 824 | 15 min | 6 | $ 142.45 | $ 126.78 |
| 4617 | Mobile crisis response - two person response, both Licensed - up to 90 minutes | H2011 | Crisis Intervention service, per 15 min | HE, HK | 824 | 15 min | 6 | $ 209.93 | $ 186.84 |
| 4618 | Mobile Crisis Response (90 - 180 minutes) Two person response - Licensed and Unlicensed/Certified Peer | S9485 | Crisis intervention mental health services, per diem | HE, U5 | 824 | Per Diem | 1 | $ 1,282.06 | $ 1,141.03 |
| 4619 | Mobile Crisis Response (90 - 180 minutes) Two person response - both licensed | S9485 | Crisis intervention mental health services, per diem | HE, HK, U5 | 824 | Per Diem | 1 | $ 1,889.35 | $ 1,681.52 |
| 4620 | Mobile Crisis Response- Per Diem |
| Requires a minimum 3 hours of face-to-face contact - Two person response, Licensed and Unlicensed/Certified Peer | S9485 | Crisis intervention mental health services, per diem | HE | 824 | Per Diem | 1 | $ 1,709.41 | $ 1,521.37 |
| 4621 | Mobile Crisis Response- Per Diem |
| Requires a minimum 3 hours of face-to-face contact - Two person response, both Licensed. | S9485 | Crisis Intervention mental health service, per diem | HE, HK | 824 | Per Diem | 1 | $ 2,519.13 | $ 2,242.03 | ||
| 4622 | Crisis follow up - face to face - One person response, Licensed - up to 90 minutes | H2011 | Crisis intervention service, per 15 minutes | TS | 824 | 15 min | 6 | $ 87.47 | $ 77.85 | |
| 4623 | Crisis follow up - face to face - One person response, Unlicensed/Certified Peer - up to 90 minutes |
| H2011 | Crisis intervention service, per 15 minutes | TS, HE | 824 | 15 min | 6 | $ 32.80 | $ 29.19 | ||
| 4624 | Crisis follow up - face to face - Two person response, one Licensed and one Unlicensed/Certified Peer - up to 90 minutes | H2011 | Crisis intervention service, per 15 minutes | TS, SC | 824 | 15 min | 6 | $ 120.27 | $ 107.04 |
| *Downstate counties include the five counties comprising New York City (Bronx, Kings, New York, Queens, and Richmond), Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk, and Westchester. |
| **Rate code 4610 and 4612, telephonic crisis response services may be provided by crisis intervention staff under supervision of a crisis intervention professional when conducting service planning, crisis/safety planning, or care coordination services as outlined in the Medicaid State Plan. |
***Rates are subject to change, and are pending CMS and DOB approval.
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