MedicaidReimbursementHigh impact
Newsletter Vol. 26, No. 01
New Jersey Medicaid·NJ · Palliative Care·Reimbursement
Effective date
Jan 1, 2016
We identified it
Jun 20, 2026
Summary
New Jersey implemented dual reimbursement rates for hospice Routine Home Care (T2042) effective January 1, 2016, with a higher rate for the first 60 days and lower rate thereafter. Additionally, a new Service Intensity Add-On payment (T2043) was established for RN or social worker visits during the last 7 days of life, limited to 4 units maximum. All claims must use modifier '22' and be submitted with accurate hospice day counts to receive appropriate payment.
Action Required
By January 1, 2016: Billing team must update billing software to require modifier '22' in the first modifier position for all T2042 (Routine Home Care) claims submitted during the first 60 days of hospice care. Simultaneously, implement T2043 22 billing for Service Intensity Add-On payments when RN or social worker services are provided in the last 7 days of beneficiary's life, capping units at 4 and excluding preparation/documentation time. Update claim submission processes to accurately track and calculate hospice days per beneficiary to ensure correct rate assignment. Implement monthly claim submission schedule to fiscal agent (Molina Medicaid Solutions, 1-800-776-6334) and establish process to correct and re-submit denied claims immediately. Train providers to report only actual visit hours in whole numbers for T2043 22 billing. Failure to submit with proper modifiers will result in claims being paid at incorrect rates or denied entirely. Error code 1439 will flag T2042 22 claims paid at lower rate when over 60 days have been used.