Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official eMedNY and NYSDOH guidelines | Last Updated: August 2026
New York does not use one single Medicaid fee for every service. Instead, eMedNY and the New York State Department of Health (NYSDOH) publish separate fee schedules for each provider type — like physicians, dentists, labs, and transportation.
This guide breaks down the confirmed 2026 rates by service, plus the billing changes coming in 2027.
Quick Summary
- Physician fees updated April 1, 2026
- Dental fees updated January 1, 2026
- Lab and transportation fees updated April 2026
- Mental health (HARP/CORE) rates updated July 15, 2026
- 2027 brings new billing rules, not new fee amounts yet
- See if you qualify for coverage with our Medicaid Eligibility calculator in 2026
CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only.
What Is the New York Medicaid Fee Schedule?
A Medicaid fee schedule is a list of prices. It tells doctors, dentists, and other providers how much Medicaid will pay for each service. Each fee is tied to a billing code.
New York’s schedules come from two official sources. eMedNY manages the day-to-day fee tables, and NYSDOH sets policy through its monthly Medicaid Update bulletins.
Why Rates Vary by Service
Every provider type has its own schedule. A dental cleaning code doesn’t use the same fee list as a lab test or an ambulance ride.
Why Rates Vary by Date
Fees change during the year, not just on January 1. Below, you’ll see different effective dates for different services.
2026 Fee Schedules by Service Type
Here’s a snapshot of when each 2026 schedule took effect and where it comes from.
| Service Category | Effective Date | Official Source |
|---|---|---|
| Physician & Medicine Services | April 1, 2026 | eMedNY Physician Fee Schedule |
| Dental Services | January 1, 2026 | NYS Medicaid Dental Fee Schedule |
| Laboratory Services | April 1, 2026 | eMedNY Laboratory Fee Schedule |
| Transportation (Ambulance/Ambulette) | April 5, 2026 | eMedNY Transportation Fee Schedule |
| Mental Health (HARP/CORE) | July 15, 2026 | OMH Medicaid Reimbursement Rates |
Physician & Lab Rate Examples
These are a few confirmed 2026 non-facility rates. Full code lists are on eMedNY.
| Code | Service | 2026 Rate |
|---|---|---|
| 81000 | Urinalysis | $4.00 |
| 81002 | Urinalysis | $2.02 |
| 10004 | Fine needle aspiration biopsy | $46.11 |
| 29894 | Ankle arthroscopy | $459.46 |
| 80047/80048 | Basic metabolic panel | $7.32 |
| 80053 | Comprehensive metabolic panel | $10.10 |
| 80061 | Lipid panel | $6.10 |
Dental Rate Examples
Dental fees follow the 2026 dental policy manual, effective January 1, 2026.
| Code | Service | 2026 Rate | Frequency |
|---|---|---|---|
| D0120 | Periodic oral evaluation | $25.25 | Once per 6 months |
| D0140 | Limited oral evaluation | $14.14 | — |
| D0145 | Oral evaluation, patient under 3 | $30.30 | — |
Transportation Rate Examples
These sample rates are for Albany County. Rates can differ by county.
| Code | Service | 2026 Rate |
|---|---|---|
| A0425 | Ambulance mileage | $2.53 per mile |
| A0428 | Ambulance basic life support | $190.83 |
| A0130 | Ambulette | $43.00 |
What’s Changing for 2027?
No statewide 2027 fee amounts have been published yet. But two billing rule changes are already confirmed and take effect January 1, 2027.
New Obstetric Billing Rules
For pregnancies with a due date on or after January 1, 2027, providers must bill differently. They’ll need to use specific Evaluation and Management (E/M) codes with a “TH” modifier, according to the NYS Medicaid Update, April 2026.
Faster Prior Approval Timelines
New York Medicaid Fee-for-Service (FFS) will follow new federal timelines for reviewing prior approvals. This change meets CMS interoperability rules and starts January 1, 2027, per the NYS Medicaid Update, May 2026.
Providers who want the full dollar amounts once they’re released can bookmark our Medicaid Fee Schedule FY 2027 tracker page for updates.
Provider Enrollment Changes for 2026
If you’re a provider joining the Medicaid network, a few things changed this year.
Application Fee
The 2026 calendar-year provider application fee is $750, according to eMedNY Provider Enrollment.
No More Paper Applications
As of July 2026, single-practitioner group practices can no longer mail in paper enrollment forms. All applications now go through the online Provider Services Portal.
Did Eligibility Change Too?
Fee schedules aren’t the only thing that shifted in 2026. Income rules for a related program also changed.
Starting July 1, 2026, the Essential Plan income limit dropped from 250% to 200% of the Federal Poverty Level. If your income is near that line, it’s worth checking current Medicaid Income Limits by State in 2026 and reviewing Medicaid Eligibility in 2026 rules before you apply or renew.
How to Find the Correct Fee for a Code
Fee lookups can be tricky. Use these steps to find the right rate.
- Confirm the payment system. Fee-for-service and Managed Care plans don’t always pay the same amount.
- Match the provider category. Physician, dental, lab, and transportation each use a different schedule.
- Check the exact code and modifiers. Small code differences can mean different rates.
- Verify the effective date. Rates change mid-year, not just in January.
- Review prior authorization rules. Some services need approval before Medicaid pays.
FAQ
Q: What are the New York Medicaid fee schedules for 2026?
A: New York doesn’t have one universal fee. Physician and lab rates took effect April 1, 2026. Dental rates started January 1, 2026. Transportation rates began April 5, 2026. Each is published separately on eMedNY by provider type.
Q: Has New York published a 2027 Medicaid fee schedule yet?
A: Not a full statewide one. As of August 2026, only certain 2027 billing rule changes are confirmed, like new obstetric billing codes and faster prior approval timelines. Dollar amounts for 2027 have not been released.
Q: How much does NY Medicaid pay for a dental checkup?
A: A periodic oral evaluation (code D0120) pays $25.25 under the 2026 dental fee schedule. This is allowed once every six months per patient, per NYSDOH’s dental policy manual.
Q: What is the NY Medicaid ambulance rate?
A: In Albany County, ambulance mileage (A0425) pays $2.53 per mile, and basic life support (A0428) pays $190.83. Rates can vary by county, so always check the local fee table.
Q: What is the 2026 Medicaid provider application fee in New York?
A: The provider enrollment application fee for calendar year 2026 is $750. This applies to providers applying or re-enrolling in the NY Medicaid program through eMedNY.
Q: Did NY Medicaid eligibility change in 2026?
A: Fee schedules didn’t affect eligibility, but a related program did change. Starting July 1, 2026, Essential Plan income limits dropped from 250% to 200% of the Federal Poverty Level, affecting who qualifies.
Sources & Disclaimer
Sources:
Last Updated: August 2026
CheckMedicaid.com is not affiliated with any government agency. For official eligibility or billing questions, contact your state Medicaid office or visit Medicaid.gov.
