MedicaidBilling CodesHigh impact
Newsletter Vol. 14, No. 08
New Jersey Medicaid·NJ · Pediatrics, Family Medicine, General Practice +1 more·Provider Notice
Effective date
Feb 1, 2004
We identified it
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.
Action Required
Immediately: Billing team must implement the following changes for all NJ Medicaid/NJ FamilyCare EPSDT claims: (1) Link all EPSDT incentive payment claims (W9828) to screening examination claims with matching service dates using procedure codes W9060-W9068, W9820, W9060 WT-W9068 WT; (2) Submit ALL EPSDT-related claims exclusively on Form MC-19 (not CMS 1500); (3) Update billing system validation rules to reject W9828 claims submitted without a concurrent screening code on the same date of service; (4) Update provider encounter forms and internal billing documentation with the approved EPSDT procedure code list. Consequences: Unlinked W9828 claims will be automatically pended for 30 days (Error Code 516), then denied if matching screening claims are not located. Claims submitted on CMS 1500 will be denied by Edit 247.