MedicaidBilling CodesHigh impact
Newsletter Vol. 26, No. 10
New Jersey Medicaid·NJ · Psychiatry·Reimbursement
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJFC) clarified three critical billing issues for behavioral health providers effective immediately: (1) Revenue code 914 for individual therapy bills as two 30-minute units at $68.21 each ($136.42 total for 60 minutes), not one unit; (2) H0010HF detoxification code applies only to residential settings, not ambulatory; (3) CPT 90791 and 90792 assessment codes have distinct usage rules—90791 for clinician-only assessments, 90792 for physician-required intake, with E/M codes billable separately for services outside program requirements with specific documentation and time-tracking rules.
Action Required
Immediately: (1) Billing team must update billing system to bill revenue code 914 as TWO units at $68.21 each (total $136.42) for 60-minute individual therapy sessions in hospital-based settings. (2) Remove 'ambulatory' from any detoxification billing descriptions; H0010HF applies ONLY to residential detoxification (Level III.7). Stop billing H0010HF for any ambulatory withdrawal services. (3) Implement CPT code differentiation: Train providers that CPT 90791 is for clinician-only assessments (no physician required); CPT 90792 is for physician-required intake assessments. (4) For partial care programs: Establish documentation and time-tracking protocols requiring providers to document E/M service focus, decision outcome, and time spent; deduct physician/APN encounter time from therapeutic services time (e.g., if 45-minute group interrupted for 15-minute physician visit, only 30 minutes counts toward partial care requirement). (5) Create audit rules to prevent double-billing E/M codes during partial care program hours as therapeutic time. (6) Update encounter forms and billing instructions to providers with these clarifications. Failure to comply will result in claim denials and potential overpayment recovery.