MedicaidCoverageMedium impact
Newsletter Vol. 31, No.10
New Jersey Medicaid·NJ · Psychiatry·Provider Notice
Effective date
Jul 1, 2020
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now covers Substance Use Disorder (SUD) outpatient care management services effective July 1, 2020 for FFS members, with MCO coverage beginning July 1, 2021. Independent Clinics-Drug and Alcohol providers can bill up to 2 hours per 30-day period for eligible members with SUD and complex physical or psychosocial needs. Care managers must be enrolled with individual NPIs and linked to the clinic's provider number for billing.
Action Required
REQUIREMENTS: By June 30, 2021 (for MCO transition): (1) Billing team must ensure all SUD care managers obtain individual NPI numbers by applying at https://nppes.cms.hhs.gov (allow 10 days processing). (2) Submit care manager addendum under 'provider enrollment' at www.njmmis.com to link care manager NPI to independent clinic provider number. (3) Update billing system to bill H0023HF in 15-minute units at $27.74 per unit, with rendering provider as care manager NPI and billing provider as clinic NPI/provider number. (4) Implement eligibility screening to verify members have SUD diagnosis, are receiving or recently discharged from treatment (within 6 months), and have complex needs (homelessness, SMI, or chronic physical health condition). (5) Ensure documentation includes intake assessment identifying eligibility criteria and person-centered care management plan signed by care manager, clinician, and beneficiary. (6) Configure billing system to enforce 2-hour rolling 30-day limit per member. (7) Prevent concurrent billing with case management services (ICMS, PATH, CCBHC, CMO, PACT, CSS, MH Residential Services) but allow concurrent peer/navigator services on different dates of service if same provider. Failure to complete enrollment and implement controls will result in claim denials for SUD care management services.