MedicaidBilling CodesHigh impact
Newsletter Vol. 14, No. 33
New Jersey Medicaid·NJ · Physical Therapy, Occupational Therapy, Speech Therapy·Provider Notice
Effective date
Apr 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ FamilyCare are discontinuing certain local procedure and modifier codes (Y7438, Y7439, Y7446, Y7449, Y7453, Y7457, Y7459, Y7554, Y7555, Y7557, Y7563, Y7565, Y7567) effective April 1, 2004. Providers must replace these codes with equivalent national CPT or HCPCS codes when submitting claims, or discontinue use entirely where no replacement exists.
Action Required
By April 1, 2004: Billing team must update all billing software and claim submission processes to stop accepting the 13 deleted New Jersey local procedure codes (Y7438, Y7439, Y7446, Y7449, Y7453, Y7457, Y7459, Y7554, Y7555, Y7557, Y7563, Y7565, Y7567). For claims with dates of service on or after April 1, 2004, replace deleted codes with their equivalent national codes as follows: Y7438→S5102, Y7439→S5101, Y7446→S5135, Y7449→S5120, Y7554→S8990, Y7555→97535, Y7557→97532, Y7565→H0004. For codes Y7453, Y7457, Y7459, Y7563, and Y7567 (marked NO REPLACEMENT CODE), discontinue billing entirely—do not substitute alternative codes. Update provider communication templates and encounter forms to reflect these changes. Communicate the change to all TBI Service Providers (HCBS Waiver Service providers) in your network. Claims submitted on or after April 1, 2004 using deleted local codes will be denied by the Division of Medical Assistance and Health Services.