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Newsletter Vol. 22, No.01
Act
by Oct 1, 2011
Effective date
Oct 1, 2011
Identified
Jun 20, 2026
Summary
New Jersey Medicaid (NJFC) revised coverage and reimbursement policies for drug screening tests effective October 1, 2011. CPT codes 80100, 80101, 80101QW, G0430, and G0431 are deleted. New utilization limits apply: G0434/G0434QW limited to 1 encounter per date of service and 2 per month; 80104/80104QW limited to 8 tests per date of service and 2 encounters per month; 80102 limited to 5 confirmatory tests per date of service and 2 encounters per month. G0434 and 80104 cannot be billed on the same date of service.
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What to do
by Oct 1, 2011 · 9 steps
01Billing team must immediately update billing software and claim submission protocols for New Jersey Medicaid (NJFC).
02DELETE from billing system: CPT codes 80100, 80101, 80101QW, G0430, G0431 - claims using these codes will be denied.
03IMPLEMENT utilization limits in billing software: G0434/G0434QW = 1 per date of service, maximum 2 encounters per month; 80104/80104QW = maximum 8 tests per date of service, maximum 2 encounters per month; 80102 = maximum 5 tests per date of service, maximum 2 encounters per month.
04ADD system validation rule: Prevent billing G0434/G0434QW and 80104/80104QW on same date of service; claims submitted together will be denied.
05TRAIN providers and billing staff on new codes and limits.
06For patients requiring testing beyond these limits: Providers must submit prior authorization request with CMS 1500 form, signed prescriber order, and medical justification to NJ DMAHS Office of Medical Director, P.O.
07Box 712, Trenton, NJ 08625-0712 (Attention: Drug Screen Testing).
08Failure to comply will result in claim denials for services exceeding utilization standards.
09Contact Molina Medicaid Solutions at 1-800-776-6334 with questions.
Codes mentioned
80100801018010280104G0430G0431G0434G0434QW
Original notice
Newsletter Vol. 22, No.01
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 21, No. 20HighEffective Oct 1, 2011 · PharmacyNewsletter Vol. 36, No.08HighEffective Apr 1, 2021 · PharmacyNewsletter Vol. 31, No.07HighEffective Apr 1, 2021 · PharmacyNewsletter Vol. 31, No.11HighEffective Apr 1, 2021 · PharmacyBrowse every New Jersey Medicaid change in the policy list