MedicaidReimbursementHigh impact
Newsletter Vol. 29, No.19
New Jersey Medicaid·NJ · Geriatrics, Occupational Therapy, Physical Therapy +1 more·Coding
Effective date
Dec 1, 2019
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is changing how personal care services (PCA, CNA, DDD) are billed and rounded effective December 1, 2019. Providers must now combine non-continuous units provided on the same day before rounding, with the first unit always rounding up and subsequent partial units rounding based on whether they meet or exceed half a unit. This aligns billing practices across all Medicaid home-based personal care services and supports Electronic Visit Verification (EVV) compliance mandated by the 21st Century Cures Act.
Action Required
By December 1, 2019: Billing team must implement new rounding methodology for all personal care services (PCA, CNA, DDD) billed to New Jersey Medicaid. Update billing system to: (1) aggregate all non-continuous units provided to the same consumer on the same calendar date; (2) always round the initial unit up to full unit regardless of minutes; (3) round partial units down if less than half the unit, or up if equal to or greater than half the unit. Retrain billing staff on the new rounding examples provided (e.g., 53 minutes with 15-minute unit = 4 units; 52 minutes = 3 units; 100 minutes with 60-minute unit = 2 units; 85 minutes with 60-minute unit = 1 unit). Ensure providers understand that only face-to-face billable services provided on the same calendar day may be included in the calculation. Update encounter documentation to support EVV requirements. Failure to implement correct rounding will result in claim denials and payment adjustments.