MedicaidCoverageHigh impact
Newsletter Vol. 34, No.09
New Jersey Medicaid·NJ·Medical Policy
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey FamilyCare now covers Acute Hospital Care at Home (AHCaH) services delivered in patients' homes by eligible hospitals with CMS approval and NJ DOH authorization. Hospitals must use specific revenue codes (0161) and occurrence span codes (82) for billing, and will be reimbursed at inpatient facility rates in FFS programs. This policy is effective immediately and applies to all NJ FamilyCare members approved for acute home-based care.
Action Required
Immediately: Billing team must update claims processing system to recognize and properly bill Revenue Code 0161 (Hospital at Home, R&B) with Occurrence Span Code 82 (Hospital at Home Care Dates) for NJ FamilyCare members. For direct ED admissions to Hospital at Home, bill entire admission using REV 0161 with span code 82. For inpatient-to-Hospital at Home transfers, bill appropriate inpatient revenue codes for hospital days and REV 0161 for Hospital at Home days with span code 82. Verify all contracted hospitals have active CMS AHCaH waivers and NJ DOH authorization before processing claims. Update billing system to ensure no prior authorization barriers exist for eligible Hospital at Home services (match inpatient utilization criteria). Contact Gainwell Technologies Provider Services at 1-800-776-6334 with enrollment or billing questions. Failure to use correct revenue and occurrence span codes will result in claim denials.