MedicaidCoverageLow impact
Newsletter Vol. 12, No. 02
New Jersey Medicaid·NJ · OB-GYN, Pediatrics, General Surgery·Provider Notice
Effective date
Jan 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now covers newborn circumcisions performed by certified nurse midwives in hospital settings only, effective January 1, 2002. Billing teams must recognize CPT codes 54160 and 54150 with modifier WM as reimbursable procedures when performed by CNMs in hospitals, with a maximum fee allowance of $11.20 each. Circumcisions by CNMs in non-hospital settings remain non-covered.
Action Required
By January 1, 2002: Billing team must update billing system to recognize CPT codes 54160 and 54150 with modifier WM as covered services when billed by certified nurse midwives for newborn circumcisions performed in hospital settings. Set maximum allowable fee to $11.20 for both codes. Add workflow note to verify that CNM circumcisions billed outside hospital settings (ambulatory surgery centers, clinics, offices) are rejected as non-covered. Update provider documentation to clarify that only hospital-based CNM circumcisions are Medicaid/NJ FamilyCare covered. Contact Office of Utilization Management at (609) 588-2721 with billing questions. Failure to properly configure these codes may result in claim denials or incorrect reimbursement.