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Newsletter Vol. 35, No.08
Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 20, 2026
Summary
New Jersey Medicaid is increasing reimbursement rates for primary care services to 70% of Medicare rates, effective July 1, 2025. This applies to evaluation and management codes (99202-99499) and immunization administration codes, with managed care organizations required to use these as minimum payment rates.
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What to do
by Jul 1, 2025 · 3 steps
01Billing team must verify that New Jersey Medicaid claims for primary care evaluation and management codes (99202-99499) and immunization administration codes (90465-90480) are being reimbursed at the new minimum rate of 70% of Medicare rates.
02Review managed care contracts to ensure compliance with new minimum payment requirements.
03Contact Gainwell Technologies at 1-800-776-6334 for questions about implementation.
Codes mentioned
99202992039920499205992119921299213992149921599221992229922399231992329923399238992399924199242992439924499245992519925299253992549925599281992829928399284992859929199292993049930599306993079930899309993109931599316993189932499325993269932799328993349933599336993379934199342993439934499345993479934899349993509938199382993839938499385993869938799391993929939399394993959939699397994019940299403994049941199412994209942999441994429944399444994919949299493994949949599496994979949899499904659046690467904689047190472904739047490480
Original notice
Newsletter Vol. 35, No.08
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 12, No. 80HighEffective Sep 9, 2002 · Provider NoticeNewsletter Vol. 23, No.08MediumEffective Jan 1, 2013 · Provider NoticeNewsletter Vol. 12, No. 82HighEffective Sep 9, 2002 · Provider NoticeMedicaid Alert MA2021-01HighEffective Apr 20, 2021 · CodingBrowse every New Jersey Medicaid change in the policy list
Related policy hubs
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