MedicaidPrior AuthMedium impact
Newsletter Vol. 32, No.06
New Jersey Medicaid·NJ · OB-GYN, Pediatrics, Family Medicine +1 more·Medical Policy
Effective date
Mar 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare expanded breastfeeding equipment coverage effective March 1, 2022. Double electric breast pumps (E0603) now require prior authorization only for hands-free models; manual pumps (E0602) and multi-user hospital-grade pumps (E0604) available without prior auth (except hospital-grade requires prior auth for rental). Additional breast pump supplies (tubing, adapters, shields, bottles, storage bags) covered without prior authorization; hands-free bra (A9900) requires prior auth. All pumps must meet updated minimum specifications and be delivered within specified timeframes (24-72 hours depending on type and setting).
Action Required
By February 28, 2022: Billing team must update billing system and DME supplier workflows for NJ FamilyCare claims to reflect new prior authorization requirements: (1) E0603 double electric pumps—prior auth REQUIRED ONLY for hands-free models (with SC modifier); standard E0603 pumps purchase-only, no prior auth needed; (2) E0602 manual pumps and E0604 multi-user pumps—no prior auth required for rental/purchase decisions; (3) Replacement supplies A4281-A4286 and K1005—process without prior auth; (4) A9900 hands-free bra—require prior auth. Update EMR/billing system to enforce delivery timeframes: single-user pumps within 24-48 hours postpartum (72 hours prenatal), multi-user within 12 hours all settings. Remove prior auth requirements for standard E0603 and E0602 codes in billing system rules. Train DME supplier staff on new specifications and delivery requirements. Notify in-network providers and MCO partners of changes. Flag any claims submitted March 1+ with E0603 (standard, non-hands-free) requiring prior auth for denial/resubmission. Failure to comply will result in unnecessary claim denials and delayed member access to equipment.