MedicaidPrior AuthHigh impact
Newsletter Vol. 12, No. 58
New Jersey Medicaid·NJ · Dentistry·Provider Notice
Effective date
Jul 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJFC/FFS) is implementing utilization thresholds for dental behavioral management services (CPT 09920) to reduce prior authorization requirements. Starting July 1, 2002, DBM services no longer require pre-authorization if they stay within place-of-service-specific time limits (30 min for office/clinic, 60 min for hospital, 15 min for skilled nursing). Claims exceeding thresholds will be denied with Error Code 705 unless prior authorization is obtained. All claims must now include place of service in Field 17K or face denial with Error Code 141.
Action Required
By July 1, 2002: Billing team must immediately implement the following changes: (1) Update billing software to enforce utilization thresholds by place of service for CPT 09920—automatically flag claims exceeding 30 minutes (office/clinic), 60 minutes (inpatient/outpatient hospital), or 15 minutes (skilled nursing facility); (2) Ensure all dental claim forms include place of service code in Field 17K using values 1, 3, 5, 7, or 8; (3) Configure system to submit Error Code 141 denials for any claims without a place of service value; (4) Establish workflow to route claims exceeding thresholds to prior authorization process before submission; (5) Train providers and front-desk staff that prior authorization is ONLY required when DBM services exceed the time threshold for that specific place of service. Consequences: Claims without place of service will be denied (Error Code 141); claims exceeding thresholds without prior authorization will be denied (Error Code 705); non-compliant claims will not be paid.