MedicaidPrior AuthHigh impact
Newsletter Vol. 29, No.06
New Jersey Medicaid·NJ · Family Medicine, General Practice, Psychiatry +1 more·Prior Authorization
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
New Jersey eliminates prior authorization requirements for all Medication Assisted Treatment (MAT) medications and services effective January 1, 2019, and establishes the Office Based Addictions Treatment (OBAT) program to expand MAT access through primary care providers. The policy introduces new reimbursement codes for Navigator services and increases intake/evaluation assessment rates effective April 1, 2019.
Action Required
By January 1, 2019: Billing team must immediately stop submitting prior authorization requests for all MAT medications (buprenorphine/naloxone, buprenorphine only, naltrexone oral, naltrexone XR, methadone oral, Sublocade, Probuphine) and MAT-related bundled services to NJ FamilyCare MCOs. Update billing system to remove prior auth requirements for CPT codes 99201HF-99205HF, 99211HF-99215HF, and HCPCS codes H0020HF, H0020HF26, H0033HF, H0033HF26. By April 1, 2019: Providers must verify Navigator service codes (H0006HFHG, H0006HFSU, H0006HF) are active in billing system with updated rates ($438.17 for 90792HF, $152 for H0006HFHG one-time, $76 for H0006HFSU weekly, $76 for H0006HF monthly). Verify OBAT provider enrollment status with NJ FamilyCare and contracted MCOs to confirm eligibility to bill these new codes. Ensure providers meet OBAT standards (DATA 2000 waiver, multi-disciplinary staff, Navigator employment, counseling arrangements). Claims will be denied if prior auth is submitted or if provider does not meet participation standards.