MedicaidCoverageMedium impact
Newsletter Vol. 30, No.15
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, General Practice·Coding
Effective date
Dec 1, 2019
We identified it
Jun 20, 2026
Summary
NJ FamilyCare now covers CenteringPregnancy group prenatal visits for CHI-credentialed sites. Billing teams must code individual E/M services (99212-99215) for each pregnant woman participant, plus add CPT 99078 TH for group education services. Providers receive an additional $7.00 per Medicaid beneficiary per group visit.
Action Required
By December 1, 2019 (retroactive - implement immediately for current CenteringPregnancy sites): (1) Billing team must configure system to bill CPT codes 99212-99215 for each individual patient in CenteringPregnancy group visits based on documented complexity level. (2) Add CPT 99078 with TH modifier (obstetrical treatment) as mandatory add-on code billed on same date of service with E/M code. (3) Update billing logic to apply $7.00 additional payment per NJ FamilyCare Medicaid beneficiary when 99078 TH is billed. (4) Train providers and front desk to document that groups contain 2-20 pregnant women, visits are minimum 90 minutes, and each beneficiary does not exceed 10 reimbursable group visits per pregnancy. (5) Verify CenteringPregnancy site CHI credentialing status in provider database; no additional enrollment application required. (6) Instruct providers to document E/M level based solely on individual patient medical encounter, NOT group education activities. Claims billed without compliance to these requirements may be denied.