MedicaidBilling CodesHigh impact
Medicaid Alert MA2021-01
New Jersey Medicaid·NJ·Coding
Effective date
Apr 20, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now allows modifier 25 to be appended to specific E&M codes when billing for significant and separately identifiable evaluation and management services performed on the same day as other procedures. This resolves previous system denials and allows for proper reimbursement of these combined services.
Action Required
Immediately: Billing team must update billing software and procedures to allow modifier 25 on the specified E&M codes for New Jersey Medicaid claims. Train staff to append modifier 25 when appropriate documentation supports a significant and separately identifiable E&M service. Resubmit any previously denied claims with Error Code 1896 that have service dates within 12 months. Ensure documentation clearly supports the use of modifier 25 as claims may be subject to post-payment review.