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MedicaidBilling CodesMedium impact

Newsletter Vol. 32, No.13

New Jersey Medicaid·NJ · OB-GYN, Family Medicine·Medical Policy
Effective date
May 1, 2022
We identified it
Jun 20, 2026
Days to comply

Summary

New Jersey Medicaid/NJ FamilyCare now allows Certified Midwives (CM) and Certified Professional Midwives (CPM) to enroll as providers, expanding beyond just CNMs. For fee-for-service claims starting July 1, 2022, midwives must add the 'SB' modifier to most professional services for reimbursement.

Action Required

Action needed
By July 1, 2022: Billing team must update billing system to require 'SB' modifier for all midwife professional services in NJ Medicaid fee-for-service except CenteringPregnancy 99078 TH, family planning clinic services, laboratory services, vaccinations, and specified drug administration codes. Update encounter forms and billing software rules. Claims without proper SB modifier will not be reimbursed.

Affected Billing Codes

H1000
H1001
59400
59409
59410
59425
59426
59430
59610
59612
59614
59514
59620
99202
99203
99204
99205
99211
99212
99213
99214
99215
99221
99231
99232
99238
99341
99342
36415
51701
51702
59020
59025
59030
59200
59300
59412
96127
96160
98960
98961
98962
99406
99407
99473
99474
54150
54160
92650
92651
99460
99461
99462
99463
99384
99385
99386
99387
99394
99395
99396
99397
G9920
G9919
51700
56420
56501
56605
56606
56820
56821
57061
57100
57150
57160
57170
57180
57420
57421
57452
57454
57455
57456
57465
57511
58100
58110
11976
11981
11982
11983
58300
58301
96372
96374
96375
96379
99078
J1050
J1726
J1729
J2788
J2790
J2791
J2792
J7294
J7295
J7296
J7297
J7298
J7300
J7301
J7304
J7307