All PlansPrior AuthMedium impact

Newsletter Vol. 13, No. 14

Q: Who is affected by this change?

This affects New Jersey Medicaid Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy, Occupational Therapy, ENT (Ear, Nose & Throat), Ophthalmology providers in NJ on All Plans plans.

New Jersey Medicaid·NJ · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +3 more·Prior Authorization

Effective date

Not stated

We identified it

Jun 20, 2026

Days to comply

—

Summary

New prior authorization requirements are now in effect for durable medical equipment, medical supplies, prosthetics and orthotics, and hearing aids specifically for patients residing in Bergen and Passaic Counties in New Jersey.

Action Required

Action needed

Immediately: Billing team must verify patient addresses and implement prior authorization workflow for all DME, medical supplies, prosthetics, orthotics, and hearing aids when patients reside in Bergen or Passaic Counties, NJ. Update billing system to flag these counties. Front desk staff must collect complete address information during registration to ensure compliance.

Related policy hubs

New Jersey Medicaid policies NJ policy changes Orthopedics PM&R (Physical Medicine & Rehab)Physical Therapy Occupational Therapy ENT (Ear, Nose & Throat)Ophthalmology