MedicaidBilling CodesHigh impact
Newsletter Vol. 14, No. 51
New Jersey Medicaid·NJ · Nephrology·Provider Notice
Effective date
Oct 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid requires freestanding ESRD providers to report HCPCS code Q4055 and actual EPO units (per 1000) in addition to existing revenue codes 634/635 on UB-92 claims. Reimbursement rate is standardized at $12.26 per 1000 units effective October 1, 2004.
Action Required
By October 1, 2004: Billing team must update UB-92 claim submission procedures for all freestanding ESRD centers. (1) Continue reporting revenue codes 634 (less than 10,000 units) and 635 (10,000 or more units) in the revenue code field. (2) Add HCPCS code Q4055 in Field No. 44 (HCPCS/Rates) on all EPO claims. (3) Report actual EPO units provided expressed per 1000 in Field 46 (e.g., report '10' for 10,000 units). (4) Update billing system to enforce new reimbursement rate of $12.26 per 1000 units. Verify Unisys claims processor accepts new format. Failure to report Q4055 and units per 1000 will result in claim denials or payment delays.