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Newsletter Vol. 13, No. 40
New Jersey Medicaid·NJ · Pediatrics, Family Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy update addresses coverage guidelines for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services related to Private Duty Nursing (PDN) services. The change appears to clarify coverage criteria and billing requirements for pediatric patients requiring private duty nursing care under EPSDT provisions.
Action Required
Review the full policy document at https://www.njmmis.com/documentDownload.aspx?document=13-40.pdf to understand specific coverage changes for EPSDT Private Duty Nursing services. Billing team should verify current authorization requirements and documentation standards for pediatric PDN claims. Update billing procedures if new coverage criteria or prior authorization requirements are specified in the complete policy.