MedicaidReimbursementHigh impact
Newsletter Vol. 18, No. 11
New Jersey Medicaid·NJ · Dentistry·Provider Notice
Effective date
Jul 1, 2008
We identified it
Jun 20, 2026
Summary
Effective July 1, 2008, NJ FamilyCare/Medicaid revised claims processing for behavior management (CDT D9920) in dental services. Behavior management cannot be reimbursed when provided on the same date as general anesthesia or IV sedation; if both services are billed, reimbursement for general anesthesia will be reduced by the amount paid for behavior management. Behavior management claims must be submitted with associated dental procedure codes and prior authorization numbers when applicable.
Action Required
By July 1, 2008: Billing team must implement the following controls in the dental claims processing system: (1) Block submission of D9920 (behavior management) on the same claim or date of service as D9220, D9221, D9241, or D9242 (general anesthesia or IV sedation); (2) Require that all D9920 claims include associated dental procedure codes and prior authorization numbers for denture/crown services with multiple office visits; (3) Implement automated reduction of general anesthesia reimbursement if behavior management was previously paid on separate claims for the same date of service. Train dental providers and billing staff on these new requirements. Update claim submission instructions and prior authorization procedures. Failure to comply will result in claim denials or overpayment recovery.