MedicaidReimbursementHigh impact
Newsletter Vol. 13, No. 34
New Jersey Medicaid·NJ · General Surgery, Podiatry·Coding
Effective date
May 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now allows separate reimbursement for Evaluation and Management (E&M) codes billed on the same date of service as surgical procedures by the same physician, provided separately identifiable problems or diagnoses support both services. This reverses previous bundling restrictions and enables practices to bill both services together when clinically justified.
Action Required
Immediately: Billing team must update NJ Medicaid claim submission procedures to allow E&M and surgical procedure codes to be billed together on the same date of service when performed by the same physician. Update claim scrubber rules to remove edits that previously bundled these services. Ensure providers document separately identifiable problems or diagnoses in the medical record to support dual billing. Train billing staff and providers that both codes are now separately reimbursable under NJ Medicaid/NJ FamilyCare FFS when clinical documentation supports medical necessity for both services on the same date. Failure to bill both services when appropriate may result in lost reimbursement.