MedicaidPrior AuthMedium impact
Newsletter Vol. 12, No. 54
New Jersey Medicaid·NJ · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +3 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now requires prior authorization for durable medical equipment, medical supplies, prosthetics, and orthotics specifically for residents of Bergen and Passaic Counties. This adds a geographic restriction to existing prior auth requirements.
Action Required
Immediately: Billing team must verify patient addresses for all DME, prosthetics, and orthotics orders. For Bergen and Passaic County residents on NJ Medicaid, obtain prior authorization before ordering equipment. Update patient intake forms to capture county information and add alerts in billing system for these two counties.