MedicaidBilling CodesHigh impact
Newsletter Vol. 28, No.23
New Jersey Medicaid·NJ·Provider Notice
Effective date
Oct 1, 2018
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJ FamilyCare) is transitioning from AP-DRG Version 27 to APR-DRG Version 34 for inpatient hospital reimbursement effective October 1, 2018. All claims must now include a four-digit APR-DRG code (three-digit base DRG plus one-digit severity indicator). Claims submitted without all four digits will be denied.
Action Required
By October 1, 2018: Billing team must update all inpatient billing systems and software to require and validate four-digit APR-DRG Version 34 codes (instead of three-digit AP-DRG v27 codes) for all NJ FamilyCare/Medicaid claims with discharge dates on or after October 1, 2018. Update coding guidelines and staff training materials. For discharges prior to October 1, 2018, continue submitting three-digit codes only—four-digit submissions for pre-October claims will be denied. Download the new APR-DRG v34 weights and pricing from NJMMIS.COM (DRG Pricing/Rate and Code Information). Medical records and patient account managers must ensure discharge abstracts capture the correct four-digit APR-DRG. Failure to submit four-digit codes for post-October claims will result in claim denials.