MedicaidPrior AuthMedium impact
Newsletter Vol. 31, No.17
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, Pediatrics·Medical Policy
Effective date
Apr 5, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare updated breastfeeding equipment coverage with revised breast pump specifications, delivery timeframes, and coding requirements. Key changes include hands-free pumps requiring prior authorization (E0603 with SC modifier) and specific delivery timeframes for different pump types.
Action Required
Billing team must update system to require prior authorization for hands-free breast pumps (code E0603 with SC modifier) and hands-free breastfeeding bras (A9900). Update encounter forms to reflect that standard double electric pumps (E0603 without SC modifier) no longer require prior auth. Ensure DME providers understand delivery timeframe requirements to avoid reimbursement for member out-of-pocket purchases.