MedicaidBilling CodesMedium impact
CSOCI Newsletter Vol. 02, No. 03
New Jersey Medicaid·NJ · Psychiatry, Pediatrics·Provider Notice
Effective date
May 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey's Children's System of Care Initiative establishes specific HCPCS procedure codes for billing therapeutic leave and hospital leave services at non-JCAHO accredited residential child care facilities. Facilities can now bill for up to 14 continuous days per episode when residents are temporarily absent, using distinct codes for mental health services and room/board depending on whether the absence is therapeutic or hospital-related and whether the facility contracts with DMHS or DYFS.
Action Required
By May 1, 2002: Billing team must implement new HCPCS codes Y9992–Y9999 in the billing system for non-JCAHO accredited residential child care facilities, children's group homes, and psychiatric community residences under contract with New Jersey DMHS or DYFS. Specifically: (1) Configure billing software to require TWO codes per day during leave periods—one for therapeutic/rehabilitation services and one for room and board; (2) Establish system rules limiting therapeutic and hospital leave billing to maximum 14 consecutive days per episode; (3) Update claim submission guidelines to ensure leave dates are billed on separate lines from regular service dates and do not span multiple months on the same line; (4) Train billing staff to use appropriate codes based on leave type (Y9992–Y9993 for therapeutic leave under DMHS contract, Y9994–Y9995 for hospital leave under DMHS contract, Y9996–Y9997 for therapeutic leave under DYFS contract, Y9998–Y9999 for hospital leave under DYFS contract); (5) Ensure providers understand that these codes apply only when child is absent for entire 24-hour periods—if child is present any part of the day, regular codes must be used instead. Failure to implement will result in claim denials for leave periods.