NY Healthfirst Increases Fees for Medicaid, Child Health Plus, QHP/Marketplace/Essential Plans
Healthfirst announced an increase in the reimbursement rates for the services provided. It will go into force from September 1, 2024. Medicaid, Child Health Plus, Qualified Health Plan (QHP)/Marketplace, and Essential Plans will all be affected by the fee adjustments.
The reimbursement rate increase comes on the heels of an extensive analysis regarding the costs associated with the treatment of Healthfirst members receiving services.
The fee increase applies to a wide range of dental procedures and codes, as outlined in the revised fee schedule.
Increase in the Medicaid Adult Plan
The increase in fees associated with different dental codes is presented below for better understanding.
| Codes | Fees | Codes | Fees | Codes | Fees | Codes | Fees |
|---|---|---|---|---|---|---|---|
| D0120 | $21.46 | D1110 | $38.63 | D2391 | $50.00 | D2954 | $124.99 |
| D0140 | $12.02 | D1320 | $8.59 | D2392 | $66.99 | D3310 | $249.98 |
| D0150 | $25.76 | D2140 | $42.93 | D2393 | $81.99 | D3320 | $299.97 |
| D0210 | $42.93 | D2150 | $57.52 | D2394 | $84.13 | D3330 | $399.96 |
| D0230 | $4.29 | D2160 | $70.40 | D2740 | $499.95 | D4341 | $38.63 |
| D0272 | $12.02 | D2330 | $50.00 | D2750 | $499.95 | D4342 | $25.76 |
| D0274 | $20.60 | D2331 | $72.99 | D2751 | $499.95 | D4910 | $38.63 |
| D0330 | $30.05 | D2332 | $86.99 | D2752 | $499.95 | D5110 | $559.94 |
| D0350 | $10.30 | D2335 | $97.99 | D2920 | $25.76 | 5120 | $559.94 |
| Codes | Fees | Codes | Fees |
|---|---|---|---|
| D5213 | $559.94 | D9239 | $65.25 |
| D5214 | $559.94 | D9243 | $65.25 |
| D7140 | $50.00 | D9430 | $17,17 |
| D7210 | $84.99 | D9944 | $124.48 |
| D7230 | $154.53 | D9945 | $124.48 |
| D7240 | $257.55 | D9946 | $124.48 |
| D9110 | $21.46 | ||
| D9222 | $65.25 | ||
| D9223 | $65.25 |
Increase in the Medicaid Child Health Plus Plan
The increase in fees associated with different dental codes is presented below for better understanding.
| Codes | Fees | Codes | Fees | Codes | Fees | Codes | Fees |
|---|---|---|---|---|---|---|---|
| D0145 | $25.76 | D2140 | $42.93 | D2392 | $66.99 | D2954 | $124.99 |
| D0150 | $25.76 | D2150 | $57.52 | D2393 | $81.99 | D3220 | $74.69 |
| D0210 | $42.93 | D2330 | $50.00 | D2740 | $499.95 | D3310 | $249.98 |
| D0340 | $47.22 | D2331 | $72.99 | D2750 | $499.95 | D3320 | $299.97 |
| D0470 | $29.19 | D2332 | $86.99 | D2751 | $499.95 | D3330 | $399.96 |
| Di120 | $36.92 | D2335 | $97.99 | D2752 | $499.95 | D5213 | $559.94 |
| D1208 | $12.02 | D2391 | $50.00 | D2930 | $99.59 | D5214 | $559.94 |
Increase in the Healthfirst QHP/Marketplace/Essential Plans
The increase in fees associated with different dental codes is presented below for better understanding.
| Codes | Fees | Codes | Fees | Codes | Fees | Codes | Fees |
|---|---|---|---|---|---|---|---|
| D0120 | $24.65 | D0350 | $11.90 | D2391 | $50.00 | D2954 | $124.99 |
| D0140 | $13.43 | Di110 | $49.30 | D2392 | $66.99 | D3310 | $249.98 |
| D0150 | $28.79 | D1320 | $9.60 | D2393 | $81.99 | D3320 | $299.97 |
| D0210 | $49.30 | D2140 | $47.98 | D2394 | $94.03 | D3330 | $399.96 |
| D0220 | $11.90 | D2150 | $64.29 | D2740 | $499.95 | D4341 | $43.18 |
| D0230 | $5.95 | D2160 | $78.68 | D2750 | $499.95 | D4342 | $28.79 |
| D0270 | $11.90 | D2330 | $50.00 | D2751 | $499.95 | D4910 | $43.18 |
| D0272 | $14.45 | D2331 | $72.99 | D2752 | $499.95 | D5110 | $559.94 |
| D0274 | $24.65 | D2332 | $86.99 | D2920 | $28.79 | D5120 | $559.94 |
| D0330 | $34.00 | D2335 | $97.99 | D2952 | $119.9 | D5213 | $559.94 |
| Codes | Fees | Codes | Fees |
|---|---|---|---|
| D5214 | $559.94 | D9310 | $47.25 |
| D7140 | $50.00 | D9430 | $19.19 |
| D7210 | $84.99 | D9944 | $139.13 |
| D7230 | $172.71 | D9945 | $139.13 |
| D7240 | $287.85 | D9946 | $139,13 |
| D9110 | $23.99 | ||
| D9222 | $72.92 | ||
| D9223 | $72.92 | ||
| D9239 | $72.92 |
This step will surely mark a change in the face of health coverage. It will bring about serious changes that will influence the affordability and accessibility of healthcare for many in the long run.
