MedicaidPrior AuthMedium impact
Newsletter Vol. 26, No.18
New Jersey Medicaid·NJ · OB-GYN, Orthopedics, Neurosurgery +1 more·Coding
Effective date
Oct 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has updated the ICD-10 procedure codes that require second surgical opinions for elective procedures including hysterectomy, spinal fusion, laminectomy, and hernia repair. This replaces previous ICD-9 code lists for claims with service dates on or after October 1, 2015.
Action Required
For New Jersey Medicaid claims: Prior to scheduling elective hysterectomy, spinal fusion, laminectomy, or hernia repair procedures, verify second surgical opinion requirement using updated ICD-10 procedure codes. For urgent/emergent cases, attach operative report, discharge summary, and physician attestation to hard copy claims. For administrative waivers, attach FD-263 form to hard copy claims. Update billing system to flag these procedures for second opinion verification before claim submission.