MedicaidCoverageMedium impact
Newsletter Vol. 12, No. 33
New Jersey Medicaid·NJ · OB-GYN·Provider Notice
Effective date
Feb 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers first assistant services performed by qualified Certified Nurse-Midwives at Cesarean deliveries in in-patient hospital settings. Billing teams must use the specified procedure codes with modifiers WM 80 for claims with service dates on or after February 1, 2002. Coverage is limited to hospital-based cesarean deliveries only; other settings are not covered.
Action Required
On or after February 1, 2002: Billing team must update billing software and fee schedules to recognize CPT codes 59514, 59620, and W9031 with modifier WM 80 as covered services for Certified Nurse-Midwife first assistant services at in-patient hospital Cesarean deliveries. Input maximum fee allowances: $45.15 for codes 59514 and 59620, and $62.48 for W9031. Train providers and billing staff that first assistant services by Certified Nurse-Midwives are ONLY covered in in-patient hospital settings; deny or reject claims for first assistant services by Certified Nurse-Midwives in non-hospital settings (ambulatory surgery centers, birthing centers, etc.). Update claim submission guidelines and encounter documentation forms to reflect this coverage change. Contact Office of Utilization Management at (609) 588-2721 with questions.