MedicaidReimbursementMedium impact
Newsletter Vol. 34, No.12
New Jersey Medicaid·NJ·Provider Notice
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Effective October 1, 2024, New Jersey Medicaid (NJFC) is reducing reimbursement rates for COVID-19 laboratory tests from Medicare rates to 80% of Medicare rates. Coverage remains without member cost-sharing, but providers will receive lower payment. This change applies to all COVID labs covered by the Division of Medical Assistance and Health Services (DMAHS).
Action Required
By October 1, 2024: Billing team must update fee schedules in billing software to reflect the new reimbursement rate of 80% of Medicare for all COVID-19 laboratory tests covered by New Jersey Medicaid. Update internal rate tables and verify that claims submitted for COVID labs on or after October 1, 2024 are billing at the reduced rate. Contact Gainwell Technologies Provider Services (1-800-776-6334) if the billing system requires technical updates to implement the rate change. Staff should be notified that COVID-19 lab reimbursement has decreased to prevent claim submission errors.