MedicaidCoverageHigh impact
Newsletter Vol. 24, No.03
New Jersey Medicaid·NJ · Psychiatry·Provider Notice
Effective date
Jan 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey expanded NJ FamilyCare (NJFC) coverage effective January 1, 2014 to include mental health and substance abuse services for parents, single adults, and childless couples earning up to 133% of Federal Poverty Level under a new Alternative Benefit Plan (ABP). Billing teams must implement new HCPCS/CPT procedure codes with specific modifiers and fee allowances for substance abuse treatment, psychiatric emergency services, and behavioral health services. All ABP mental health and substance abuse claims are paid fee-for-service regardless of managed care enrollment, and beneficiaries have zero co-payment responsibility for these covered services.
Action Required
By January 1, 2014 (retroactive): Billing team must immediately update billing system to recognize all 18 procedure codes listed in Attachment A with corresponding modifiers (HF, 22, 26, 52) and maximum fee allowances for ABP-eligible beneficiaries with Program Status Codes 762 and 380. Configure system to: (1) Route all ABP mental health and substance abuse claims to fee-for-service processing regardless of beneficiary managed care enrollment; (2) Remove co-payment requirements for these services; (3) Apply correct modifier-specific fees (e.g., H0046 with modifier 22 = $480.00, modifier 52 = $120.00); (4) Use REVS (1-800-676-6562) or eMEVS (www.njmmis.com) to verify ABP eligibility for new populations. Update intake/eligibility verification procedures to identify parents, single adults, and childless couples with incomes up to 133% FPL as ABP-eligible. Providers must ensure practitioners meet credential requirements (LCADC, LCSW, LPC, LMFT, Licensed Clinical Psychologist) and facilities meet DHS licensure standards. Failure to bill correctly will result in claim denials or downcoding. Retain newsletter for reference and contact Molina Medicaid Solutions Provider Services (800-776-6334) with questions.