MedicaidBilling CodesMedium impact
Newsletter Vol. 11, No. 58
New Jersey Medicaid·NJ · Family Medicine, OB-GYN·Provider Notice
Effective date
Jun 1, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and FamilyCare now reimburse family planning clinics for Lunelle Contraceptive Injection using HCPCS code W9353 (drug cost based on lower of AWP or acquisition cost, currently $24.95 per 0.5ml) and CPT code 90782 for injection administration ($2.50). Effective June 1, 2001, clinics may also bill separately for office visit evaluation and management codes.
Action Required
By June 1, 2001: Billing team must update billing system to recognize and separately bill HCPCS code W9353 for Lunelle drug cost and CPT code 90782 for injection administration to New Jersey Medicaid and FamilyCare beneficiaries. Ensure billing software calculates W9353 reimbursement as the lower of AWP ($24.95 current maximum) or actual acquisition cost, and enters this amount in BLOCK 24F on the 1500 HCFA claim form. Verify that 90782 is billed at $2.50 maximum allowance. Providers and front desk staff should understand that office visit E/M codes may be billed separately. Update encounter forms and billing workflows to identify Lunelle injections as a separately billable service. Failure to use correct codes will result in claim denials or underpayment.