MedicaidBilling CodesHigh impact
Newsletter Vol. 21, No. 20
New Jersey Medicaid·NJ · Pharmacy, Pathology, Occupational Medicine +3 more·Pharmacy
Effective date
Oct 1, 2011
We identified it
Jun 20, 2026
Summary
New Jersey FamilyCare/Medicaid is revising drug screening test coverage effective October 1, 2011. Five CPT codes (80100, 80101, 80101QW, G0430, G0431) are deleted. New utilization limits apply: G0434/G0434QW allows maximum 1 encounter per date of service and 2 per month; CPT 80104/80104QW allows maximum 5 tests per date of service and 2 encounters per month; CPT 80102 allows maximum 5 confirmatory tests per date of service and 2 encounters per month. Claims combining G0434/G0434QW with 80104/80104QW on the same date will be denied.
Action Required
By October 1, 2011: Billing team must immediately update billing system to (1) remove CPT codes 80100, 80101, 80101QW, G0430, and G0431 from all claim submission workflows; (2) implement utilization edits that enforce maximum limits for G0434/G0434QW (1 per date of service, 2 per month), 80104/80104QW (5 per date of service, 2 per month), and 80102 (5 per date of service, 2 per month); (3) create system logic to deny claims when G0434/G0434QW and 80104/80104QW are billed on the same date of service; (4) train clinical and billing staff on new frequency limits and billing restrictions. For claims exceeding utilization standards, staff must submit CMS 1500 form with signed provider order and written justification to DMAHS Office of Medical Director (P.O. Box 712, Trenton, NJ 08625-0712, Attention: Drug Screen Testing). Claims submitted without compliance will be denied. Update fee schedule to reflect new maximum allowances: G0434/G0434QW ($16.38), 80104/80104QW ($3.25 per test), 80102 ($15.00).