MedicaidBilling CodesHigh impact
Newsletter Vol. 22, No.01
New Jersey Medicaid·NJ · Pathology, Internal Medicine, Family Medicine +2 more·Pharmacy
Effective date
Oct 1, 2011
We identified it
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.
Action Required
By October 1, 2011: Billing team must immediately update billing software and claim submission protocols for New Jersey Medicaid (NJFC). ACTION ITEMS: (1) DELETE from billing system: CPT codes 80100, 80101, 80101QW, G0430, G0431 - claims using these codes will be denied. (2) IMPLEMENT 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. (3) ADD system validation rule: Prevent billing G0434/G0434QW and 80104/80104QW on same date of service; claims submitted together will be denied. (4) TRAIN providers and billing staff on new codes and limits. (5) For 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. Box 712, Trenton, NJ 08625-0712 (Attention: Drug Screen Testing). Failure to comply will result in claim denials for services exceeding utilization standards. Contact Molina Medicaid Solutions at 1-800-776-6334 with questions.