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New Jersey MedicaidMedicaid · Reimbursement · Provider Notice · NJ · Family Medicine, Internal Medicine, OB-GYN +3 moreHigh impact

Newsletter Vol. 32, No.07

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

New Jersey Medicaid has clarified reimbursement rules for physician and outpatient-administered drugs, including LARC devices. Providers must now bill their actual drug acquisition cost as the submitted charge, and use modifier 'U8' when billing 340B drugs or LARC devices.

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What to do

immediately · 3 steps
01Billing team must update procedures to bill actual drug acquisition cost (not AWP or other pricing) as the submitted charge for all physician and outpatient-administered drugs.
02Add modifier 'U8' to all 340B drugs and LARC devices when using HCPCS codes J0120-J9999 and other specified codes.
03Update billing software to reflect 340B acquisition pricing in charge field for 340B inventory drugs.

Codes mentioned

J0120J9999J7296J7297J7298J7300J7301J7307Q0144Q0181Q4079Q4080Q4081Q9945Q9964Q3025Q3026Q2009Q5101Q5103Q5104Q5105Q5106Q5107Q5108Q5110Q5111

Original notice

Newsletter Vol. 32, No.07
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 17, No. 05HighEffective Apr 1, 2007 · CodingNewsletter Vol. 17, No. 13HighEffective Aug 6, 2007 · CodingNewsletter Vol. 19, No. 18HighEffective Jun 8, 2009 · PharmacyNewsletter Vol. 19, No. 50HighEffective Nov 1, 2009 · CodingBrowse every New Jersey Medicaid change in the policy list

Related policy hubs

New Jersey Medicaid policiesNJ policy changesFamily MedicineInternal MedicineOB-GYNGeneral PracticePediatricsOncologyCode J0120Code J9999Code J7296Code J7297Code J7298Code J7300Code J7301Code J7307Code Q0144Code Q0181Code Q4079Code Q4080Code Q4081Code Q9945Code Q9964Code Q3025Code Q3026Code Q2009Code Q5101Code Q5103Code Q5104Code Q5105Code Q5106Code Q5107Code Q5108Code Q5110Code Q5111

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