MedicaidReimbursementHigh impact
Newsletter Vol. 30, No.11
New Jersey Medicaid·NJ · Psychiatry, Palliative Care·Provider Notice
Effective date
Mar 21, 2020
We identified it
Jun 20, 2026
Summary
New Jersey temporarily modified billing and delivery of partial care and partial hospitalization services during the COVID-19 emergency. Telehealth services are now reimbursed at per diem rates using H0035GTUC (1 unit per day effective 5/15/20, previously 5 units per day). Prior authorization for these services is suspended, and services may be delivered individually or in groups via telecommunication devices. Face-to-face services continue using normal billing codes and hourly rates.
Action Required
By March 21, 2020: Billing team must implement per diem billing for telehealth partial care and partial hospitalization services. From 3/21/20–5/14/20, bill H0035GTUC at 5 units per day (maximum 25 units/week). Effective 5/15/20, bill H0035GTUC at 1 unit per day (maximum 5 units/week). Remove prior authorization requirements from billing workflows. Hospitals must bill using REV code 912 or 913 at 5 units per day (maximum 25 units/week). Continue billing face-to-face services using normal hourly codes. Document any COVID-19-related service needs in treatment plans; one-time interventions in progress notes. Update billing system rules, encounter templates, and provider guidance. Failure to implement per diem billing will result in claims being denied or reprocessed at incorrect rates. Monitor for policy expiration when COVID-19 state of emergency is lifted.