Reimbursement Update for Child Abuse Pediatrics Services

Effective December 1, 2025, in alignment with the New York State Department of Health (DOH), Healthfirst Medicaid will begin reimbursing physicians certified by the American Board of Pediatrics (ABP) in Child Abuse Pediatrics a once-per-New York State (NYS) Medicaid member lifetime fee for services related to the diagnosis, treatment, or supervision of care in cases of suspected child maltreatment.

This policy applies only to the Healthfirst Medicaid line of business (LOB).

Key Update

This reimbursement applies only to physicians who have been verified and enrolled under the new specialty code for Child Abuse Pediatrics and are participating under the Medicaid LOB.

Specialty Enrollment Instructions

A new Category of Service (COS) specialty code “168” has been created for physicians with COS “0460” who are ABP-certified in Child Abuse Pediatrics. To receive this designation:

• Complete and submit the Application for Enrollment as a Specialist form available on the eMedNY website
• Once approved, the specialty code “168” will be added to your provider enrollment file.

Billing Requirements

Applicable Codes

The following CPT code has been added to the NYS Medicaid Physician Fee Schedule:

Billing Guidance

• G9012 may be billed once per NYS Medicaid member per lifetime by ABP-certified Child Abuse Pediatricians (specialty code “168”).
• It may be billed in addition to an Evaluation and Management (E&M) service on the same date of service.
• When billing for supervisory services (e.g., overseeing a physician, nurse practitioner, or physician assistant providing direct care in a child abuse case), add U2 and U2 modifiers to CPT code G9012.
• Continue to submit claims following standard NYS Medicaid policy for all other services rendered.

For detailed billing information, visit the eMedNY Physician Manual.

Healthfirst Commitment

Healthfirst is committed to supporting physicians who provide specialized, trauma-informed care to New York’s most vulnerable children. We encourage eligible providers to update their Medicaid enrollment to reflect their ABP certification in Child Abuse Pediatrics to ensure timely and accurate reimbursement under this new policy.

Additional Resources

• Application for Enrollment as a Specialist
• eMedNY Physician Manual

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.