MedicaidCoverageHigh impact
Newsletter Vol. 34, No.03
New Jersey Medicaid·NJ · ENT (Ear, Nose & Throat)·Medical Policy
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers tympanostomy tube insertion using the Tula System as an office-based procedure under local anesthesia. ENT providers instructed in the Tula System may bill CPT 0583T (unilateral) or 0583T50 (bilateral) effective immediately, with specific reimbursement rates ($1,362.12 and $1,678.62 respectively). These codes cannot be billed with nine other related CPT codes on the same date of service.
Action Required
Immediately: (1) ENT billing team must configure billing system to recognize and accept CPT 0583T and 0583T50 for New Jersey Medicaid/NJ FamilyCare claims with the specified reimbursement amounts ($1,362.12 unilateral; $1,678.62 bilateral). (2) Implement HARD STOP edit in billing software to prevent CPT 0583T or 0583T50 from being billed on the same date of service as CPT codes 69209, 69210, 69420, 69421, 69433, 69436, 69990, 92504, or 97033 (denials will result). (3) Update provider encounter templates and superbill systems to include the new Tula System procedure codes. (4) Communicate to all enrolled ENT providers that only those with documented Tula System training are authorized to bill these codes. (5) Train front desk and verification staff to identify Tula System procedures during intake and ensure proper coding assignment. (6) Retain policy documentation for audit and compliance purposes.