MedicaidBilling CodesHigh impact
Newsletter Vol. 26, No. 11
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, General Practice +1 more·Coding
Effective date
Oct 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey updated ICD-10 billing requirements for family planning and sterilization services under NJ FamilyCare. Providers must report Family Planning Indicators on CMS-1500 forms (values '2' or '3' in Field 24H) or Condition Code 'A4' on UB-04 forms, and use ICD-10-CM codes Z30 or Z31 for all claims with service dates on or after October 1, 2015. Sterilization procedures now require the completed Consent Form 7473-M ED 3-81 attached to paper claims only; claims without this form will be denied.
Action Required
EFFECTIVE IMMEDIATELY for claims with service dates on or after October 1, 2015: (1) Billing team must update billing software to automatically populate Family Planning Indicator value '2' (or '3' if EPSDT) in Field 24H of CMS-1500 claims, or Condition Code 'A4' in Field 18-28 of UB-04 claims for all family planning service claims. (2) Stop using ICD-9-CM codes V25 and V26; replace with ICD-10-CM codes Z30 (Encounter for Contraceptive Management) and Z31 (Encounter for Procreative Management) on all claims dated October 1, 2015 forward. (3) For sterilization procedures: Providers must complete Consent Form 7473-M ED 3-81, obtain required signatures from the individual (age 21+, mentally competent, voluntary informed consent per 42 CFR 441.257-441.258), and attach the original completed form to paper claim submissions only—HIPAA electronic claims are NOT accepted for sterilization procedures. (4) Disregard prior Newsletter Volume 19 No. 08 for all claims with service dates on or after October 1, 2015. Consequence: Claims for sterilization procedures submitted without the properly completed and signed Consent Form will be denied by the State of New Jersey. The State will conduct post-payment reviews and recover payments for services that do not meet family planning service definitions.