MedicaidBilling CodesHigh impact
Newsletter Vol. 14, No. 35
New Jersey Medicaid·NJ · Ophthalmology, Optometry·Provider Notice
Effective date
Apr 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ FamilyCare are deleting six local vision care procedure codes and one modifier code, effective April 1, 2004. Providers must immediately replace these codes with equivalent national CPT/HCPCS codes (or discontinue billing entirely where no replacement exists) to avoid claim denials.
Action Required
By March 31, 2004: Billing team must update all billing systems and claim submission protocols to discontinue use of deleted local codes W9200, W9210, Y5155, Y5165, Y5200, Y5201, and modifier YF for NJ Medicaid and NJ FamilyCare claims. For dates of service on or after April 1, 2004: (1) Replace W9200 with no code—do not bill; (2) Replace W9210 with CPT 92065 with modifier 22; (3) Replace Y5155 with no code—do not bill; (4) Replace Y5165 with no code—do not bill; (5) Replace Y5200 with CPT V2600, V2610, or V2615 as appropriate; (6) Replace Y5201 with CPT S0580; (7) Do not use modifier YF—remove from all templates. Update claim templates, EMR vision care encounter forms, and billing software edit rules. Notify all vision care providers in the practice of these changes. Failure to comply will result in claim denials for New Jersey Medicaid and NJ FamilyCare patients.