MedicaidAdministrativeMedium impact
Newsletter Vol. 15, No. 02
New Jersey Medicaid·NJ·Provider Notice
Effective date
Nov 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey's Division of Disability Services established a new procedure for requesting environmental and vehicular modifications for CRPD and TBI waiver beneficiaries. Instead of case management agencies paying vendors upfront and seeking reimbursement, requests now go directly to the state's fiscal intermediary for processing. Billing teams must use new procedure code S5165 with a $5,000 monthly cap per client and require completion of two new state forms (FD-408 and FD-409).
Action Required
Before processing any environmental/vehicular modification claims: (1) Billing team must update billing system to recognize procedure code S5165 and enforce the $5,000 per month per client billing limitation; (2) Case managers must obtain and use state forms FD-408 (Environmental/Vehicular Modification Request) and FD-409 (Authorization for Payment) for all modification requests—do not process requests submitted outside this form structure; (3) Ensure modification requests are submitted to the Division of Disability Services' Office of Home and Community Services (not directly to fiscal intermediary) for initial approval before vendor payment authorization; (4) Train case management staff that environmental/vehicular modifications are NOT stand-alone services and require beneficiaries to have ongoing waiver service needs; (5) Coordinate with case managers to verify beneficiary plan of care is modified to remain within monthly waiver cost caps when modifications are approved. Claims submitted without proper form documentation or exceeding the $5,000 monthly cap will be denied for reimbursement.