MedicaidBilling CodesHigh impact
Newsletter Vol. 15, No. 01
New Jersey Medicaid·NJ · Nephrology·Provider Notice
Effective date
Sep 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is changing EPO (Erythropoietin) billing requirements for freestanding ESRD providers, effective September 1, 2004. Providers must now report HCPCS code Q4055 with actual EPO units (per 1000) in specific UB-92 fields, and reimbursement is set at $12.26 per 1000 units. Revenue codes 634 and 635 continue to be used based on dosage thresholds.
Action Required
By March 7, 2005 (claims processing date): Freestanding ESRD Centers must update billing software and UB-92 claim submission processes to: (1) Report HCPCS code Q4055 in Field 44 on all EPO claims; (2) Report actual EPO units administered expressed 'per 1000' in Field 46 (e.g., 10,000 units = '10' in Field 46); (3) Continue reporting Revenue Code 634 for <10,000 units or 635 for ≥10,000 units; (4) Verify reimbursement rate is set to $12.26 per 1000 units in fee schedules. Billing team must also review claims submitted between September 1, 2004 and March 7, 2005 for potential underpayment and submit adjustments to Unisys for correction. Contact Unisys Provider Services at (800) 776-6334 with questions.