MedicaidBilling CodesHigh impact
Newsletter Vol. 13, No. 24
New Jersey Medicaid·NJ · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab)·Coding
Effective date
Jan 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare adds 19 new HCPCS codes for orthotic and prosthetic services effective January 1, 2003, with detailed maximum fee allowances. Providers must update billing systems to use these codes for lower extremity prosthetics and trunk-support orthoses (TLSO devices) to ensure proper reimbursement.
Action Required
By January 1, 2003: Billing team must add all 19 new HCPCS codes to the fee schedule in the billing system with their corresponding maximum fee allowances. Prosthetic and orthotic service providers must update claim submission procedures to use codes K0556, K0557, K0558, K0559 for lower extremity prosthetic socket inserts and codes L0450 through L0478 for TLSO orthotic devices. Update the Prosthetic and Orthotic Services Manual (N.J.A.C. 10:55) Subchapter 2 with this attachment. Claims submitted with old or incorrect codes will be denied or delayed. Contact the Office of Utilization Management at (609) 588-2739 with questions.