MedicaidCoverageMedium impact
Newsletter Vol. 12, No. 37
New Jersey Medicaid·NJ · OB-GYN, General Practice, Family Medicine +1 more·Provider Notice
Effective date
May 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey expanded coverage under the Supplementary Prenatal Care Program (NJSPCP) to include radiology and laboratory services ordered by clinics (effective May 1, 2002 for dates of service on or after July 1, 2001). Prenatal pharmaceuticals dispensed by clinics or hospitals are now covered. However, this is a limited-funded program that will cease coverage when appropriations are exhausted. Labor and delivery services remain excluded from this program.
Action Required
By May 1, 2002: Billing team must update all systems to recognize NJSPCP beneficiaries with PE Identification Cards. Update claim submission procedures to include radiology and laboratory services ordered by clinics as covered services. Verify beneficiary eligibility through REVS (1-800-676-6562) or MEVS vendor before billing. Ensure primary diagnosis codes are limited to ICD-9-CM 640-648.9 or V22-V23.89. Stop billing any pharmaceuticals under pharmacy numbers; only bill pharmaceuticals dispensed directly by clinics or hospitals. Configure systems to exclude labor and delivery services from NJSPCP coverage—direct these claims to Medical Emergency Payment Program for Aliens instead. Update encounter forms and billing templates to reflect the limitation message: 'Services limited to prenatal, provided by clinics and hospitals only, including prenatal lab and X-ray services ordered by the clinic.' Flag all NJSPCP claims for manual review until funding exhaustion notices are issued by the state. Providers should monitor state newsletters for appropriation depletion notices and prepare to deny NJSPCP claims upon receipt of such notification.