High impact
Newsletter Vol. 12, No. 58
New Jersey Medicaid·Effective Jul 1, 2002
New Jersey Medicaid (NJFC/FFS) is implementing utilization thresholds for dental behavioral management services (CPT 09920) to reduce prior authorization requirements. Starting July 1, 2002, DBM services no longer require pre-authorization if they stay within place-of-service-specific time limits (30 min for office/clinic, 60 min for hospital, 15 min for skilled nursing). Claims exceeding thresholds will be denied with Error Code 705 unless prior authorization is obtained. All claims must now include place of service in Field 17K or face denial with Error Code 141.