MedicaidBilling CodesHigh impact
Newsletter Vol. 31, No.15
New Jersey Medicaid·NJ · Geriatrics, Palliative Care·Provider Notice
Effective date
Jun 14, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is updating Adult Medical Day Care (AMDC) service delivery billing codes and requirements as facilities reopen from COVID-19 closure. Effective June 14, 2021, on-site services must be billed with S5102_U1 modifier, while remote services continue with S5102 code only. Providers cannot bill for both on-site and remote services on the same day, and must coordinate all service transitions with MCOs.
Action Required
By June 14, 2021: Billing team must update system to differentiate between on-site and remote AMDC services. For on-site services provided in compliance with N.J.A.C. 10:164, bill S5102 with U1 modifier. For remote services (telephonic outreach, meal/supply delivery, face-to-face visits), bill S5102 without modifier. Implement system edit to prevent billing both on-site and remote service on the same day per member. Update billing templates and staff training to require documentation of: (a) telephonic contact, (b) meal/supply delivery, and (c) face-to-face visits for remote service claims. Coordinate with providers to ensure they submit 10 business days' advance written notice to MCOs before reopening on-site services. Flag that remote service billing sunsets September 30, 2021, and all services must transition to on-site only by that date. Claims will be subject to post-payment review for program integrity.