Medium impact
Medicaid Alert MA-2025-03
New Jersey Medicaid·Effective Oct 1, 2025
New Jersey Medicaid is expanding the list of ICD-10-CM diagnosis codes that qualify for medical exception approval for outpatient dental services provided in a hospital operating room for beneficiaries with developmental disabilities and/or chronic medical conditions. This policy adds specific neurodevelopmental disorder codes (QA series) and clarifies which conditions meet the medical exception requirement. Prior authorization procedures and hospital reimbursement remain unchanged.