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New Jersey MedicaidMedicaid · Reimbursement · Provider Notice · NJ · OB-GYN, Family Medicine, General Practice +2 moreHigh impact

Newsletter Vol. 12, No. 74

Act
by Sep 16, 2002
Effective date
Sep 16, 2002
Identified
Jun 20, 2026

Summary

New Jersey Medicaid/NJ FamilyCare increases reimbursement rates for selected family planning services and office visit codes effective September 16, 2002. Billing teams must update fee schedules in their billing systems to reflect the new maximum allowable fees for 28 affected HCPCS and CPT codes to ensure accurate claim submission and optimal reimbursement.

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What to do

by Sep 16, 2002 · 6 steps
01Billing team must update the fee schedule in billing software for all 21 affected CPT and HCPCS codes listed in the policy.
02Verify that claims submitted for service dates on or after September 16, 2002 reflect the new maximum allowable fees (e.g., CPT 99201-99205 now $83.70, CPT 99211-99215 now $41.90, etc.).
03Update any encounter forms, charge capture templates, or billing rules that reference these codes.
04For modifier 52 codes (reduced services), ensure the lower fee schedule is applied ($79.70 for 99203-52, 99204-52, 99395-52; $37.90 for 99211-52, 99212-52, 99213-52, 99214-52, 99215-52).
05Failure to update fee schedules may result in underbilling or claim denials if rates are submitted below the new maximums.
06This applies only to New Jersey Medicaid/NJ FamilyCare fee-for-service claims; HMOs should retain for informational purposes only.

Codes mentioned

119765745257454575115830058301907829920199202992039920499205992119921299213992149921599395G0001Y7633Y7634

Original notice

Newsletter Vol. 12, No. 74
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 13, No. 06HighEffective Sep 16, 2002 · Provider NoticeNewsletter Vol. 32, No.13MediumEffective May 1, 2022 · Medical PolicyMedicaid Alert MA2021-01HighEffective Apr 20, 2021 · CodingNewsletter Vol. 32, No.03MediumEffective Jan 1, 2022 · Provider NoticeBrowse every New Jersey Medicaid change in the policy list

Related policy hubs

New Jersey Medicaid policiesNJ policy changesOB-GYNFamily MedicineGeneral PracticeInternal MedicinePediatricsCode 11976Code 57452Code 57454Code 57511Code 58300Code 58301Code 90782Code 99201Code 99202Code 99203Code 99204Code 99205Code 99211Code 99212Code 99213Code 99214Code 99215Code 99395Code G0001Code Y7633Code Y7634

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