MedicaidBilling CodesHigh impact
Newsletter Vol. 15, No. 13
New Jersey Medicaid·NJ · Nephrology·Provider Notice
Effective date
Sep 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is updating EPO (Erythropoietin) billing requirements for freestanding ESRD providers, effective September 1, 2004 for claims processed on or after March 7, 2005. Providers must now report HCPCS code Q4055 in Field 44 of the UB-92 form and the actual number of EPO units (per 1000) in Field 46, with a new reimbursement rate of $12.26 per 1000 units. Revenue codes 634 and 635 continue to be used for administration reporting.
Action Required
By March 7, 2005: Freestanding ESRD Centers billing team must immediately update UB-92 claim submission processes to: (1) Report HCPCS code Q4055 in Field No. 44 on all EPO claims; (2) Report actual EPO units provided expressed per 1000 in Field 46 (e.g., enter '10' for 10,000 units); (3) Continue reporting Revenue Code 634 for less than 10,000 units or Revenue Code 635 for 10,000 or more units; (4) Update billing system to reflect new reimbursement rate of $12.26 per 1000 units effective September 1, 2004. All previously submitted claims that were paid incorrectly under the old methodology may be adjusted. Failure to implement these changes will result in claim denials or underpayment. Contact Unisys Provider Services at (800) 776-6334 or NJ Office of Utilization Management at (609) 588-2721 with questions.