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Newsletter Vol. 14, No. 34

New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 1, 2004
We identified it
Jun 20, 2026
Days to comply

Summary

New Jersey Medicaid and NJ FamilyCare are discontinuing 16 local procedure codes and 2 local modifier codes effective April 1, 2004. Providers must replace deleted codes with specified national CPT/HCPCS equivalents or discontinue billing entirely where no replacement exists. This affects non-emergency medical transportation (NEMT) providers and requires immediate billing system updates.

Action Required

Action needed
By April 1, 2004: Billing team must immediately update billing software to discontinue acceptance of all deleted local codes (Y0004, Y0070, Y0075, Y0130-Y0240, Y8347-Y8349, Y8365-Y8366, XA modifier) for New Jersey Medicaid and NJ FamilyCare claims. For codes with replacements, configure system to automatically map or require manual entry of replacement codes: Y0004→A0425 22, Y0070→T2001, Y0075→A0422 TP, Y8365→A0425 TP, XE→GY. For codes with no replacement (Y0130, Y0140, Y0150, Y0160, Y0170, Y0180, Y0190, Y0200, Y0210, Y0220, Y0230, Y0240, Y8347, Y8348, Y8349, Y8366, XA), stop billing entirely. Communicate code changes to all transportation providers and MAV transportation providers. Implement Field 17H requirement on MC-12 claim forms to report value '5' for nursing facility transportation to obtain payment without prior authorization. Test all changes before April 1, 2004. Failure to update will result in claim denials for any claims submitted with deleted local codes.

Affected Billing Codes

Y0004
Y0070
Y0075
Y0130
Y0140
Y0150
Y0160
Y0170
Y0180
Y0190
Y0200
Y0210
Y0220
Y0230
Y0240
Y8347
Y8348
Y8349
Y8365
Y8366
A0425
T2001
A0422
GY
XA
XE