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New Jersey MedicaidMedicaid · Billing Codes · Provider Notice · NJ · Pediatrics, Family Medicine, General Practice +1 moreHigh impact

Newsletter Vol. 14, No. 08

Act
immediately
Effective date
Feb 1, 2004
Identified
Jun 20, 2026

Summary

New Jersey Medicaid/NJ FamilyCare now requires EPSDT incentive payment claims (W9828) to be submitted on the same service date as the related EPSDT screening examination claim using specific procedure codes (W9060-W9068, W9820, W9060 WT-W9068 WT). Claims must be filed on Form MC-19, not CMS 1500. Unlinked incentive claims will be pended for 30 days, then denied if the matching screening claim is not found.

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What to do

immediately · 7 steps
01Billing team must implement the following changes for all NJ Medicaid/NJ FamilyCare EPSDT claims.
02Link all EPSDT incentive payment claims (W9828) to screening examination claims with matching service dates using procedure codes W9060-W9068, W9820, W9060 WT-W9068 WT.
03Submit ALL EPSDT-related claims exclusively on Form MC-19 (not CMS 1500).
04Update billing system validation rules to reject W9828 claims submitted without a concurrent screening code on the same date of service.
05Update provider encounter forms and internal billing documentation with the approved EPSDT procedure code list.
06Consequences: Unlinked W9828 claims will be automatically pended for 30 days (Error Code 516), then denied if matching screening claims are not located.
07Claims submitted on CMS 1500 will be denied by Edit 247.

Codes mentioned

W9828W9060W9061W9062W9063W9064W9065W9066W9067W9068W9820

Original notice

Newsletter Vol. 14, No. 08
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 10, No. 70MediumEffective Sep 1, 2000 · Provider NoticeNewsletter Vol. 14, No. 53HighEffective Jan 1, 2004 · Provider NoticeNewsletter Vol. 14, No. 01MediumEffective Jan 1, 2004 · Prior AuthorizationNewsletter Vol. 14, No. 02HighEffective Jan 21, 2004 · Provider NoticeBrowse every New Jersey Medicaid change in the policy list

Related policy hubs

New Jersey Medicaid policiesNJ policy changesPediatricsFamily MedicineGeneral PracticeOB-GYNCode W9828Code W9060Code W9061Code W9062Code W9063Code W9064Code W9065Code W9066Code W9067Code W9068Code W9820

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