MedicaidCoverageHigh impact
Newsletter Vol. 27, No.13
New Jersey Medicaid·NJ · Psychiatry·Medical Policy
Effective date
Jun 5, 2017
We identified it
Jun 20, 2026
Summary
New Jersey FamilyCare (NJFC) now covers Ambulatory Withdrawal Management (AWM) services using HCPCS code H0014-HF at $220.00 per day for fee-for-service members, effective June 5, 2017. Prior authorization is required through the Interim Management Entity (IME), with initial authorizations limited to 5 days. Starting January 1, 2018, managed care plan members (MLTSS, DDD, FIDE SNP) transition to their plan for AWM coverage and prior authorization.
Action Required
REQUIREMENTS: By June 5, 2017: Billing team must implement H0014-HF billing in the practice management system at the $220.00/day rate for NJFC FFS members. Configure system to require prior authorization through IME (1-844-276-2444) before claims submission, with initial authorizations capped at 5 days. Set up separate workflow for intake assessment billing (can be billed separately in addition to per diem). By January 1, 2018: Update system to route H0014-HF claims for MLTSS, DDD, and FIDE SNP members to their respective managed care plans instead of FFS processing. Remove IME prior auth requirement for these populations effective that date and direct prior auth requests to the managed care plan. Verify that clinical documentation includes ASAM Level 2-WM criteria assessment and extended on-site monitoring justification. Configure system to prevent concurrent billing with SUD partial care programs. Failure to obtain prior authorization will result in claim denials; failure to route managed care claims correctly after January 1, 2018 will cause claim rejections.