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MedicaidPrior AuthHigh impact

Newsletter Vol. 10, No. 87

New Jersey Medicaid·NJ · Dentistry, Oral & Maxillofacial Surgery·Prior Authorization
Effective date
Dec 15, 2000
We identified it
Jun 20, 2026
Days to comply

Summary

New Jersey Medicaid is eliminating prior authorization requirements for certain dental procedures (post and core buildups, crowns, root canals, apicoectomy) effective December 15, 2000, replacing pre-payment authorization with post-payment reviews. Periodontal scaling/root planing and periodontal grafting services now allow up to 4 quadrants twice annually (or 8 quadrants annually for grafting) without PA, with PA required only for services exceeding these thresholds.

Action Required

Action needed
By December 15, 2000: Billing team must update billing system for New Jersey Medicaid FFS claims to eliminate prior authorization requirements for CPT codes 02950, 02952, 02954 (post and core buildups), 02710, 02720, 02721, 02722, 02750, 02751, 02752, 02790, 02791, 02792 (crowns), 03310, 03320, 03330 (root canals), and 03410, 03411 (apicoectomy). For CPT codes 04341, 04220 (periodontal scaling/root planing), configure system to allow 4 quadrants treated twice annually without PA; require PA only for services exceeding this threshold. For CPT codes 04210, 04211, 04260, 04261, 04262, 04270, 04271, 04272 (periodontal grafting), allow 8 quadrants annually without PA; require PA for services exceeding this threshold. Update provider documentation to reflect these changes. Providers should expect post-payment reviews instead of pre-payment authorization for the eliminated PA services. Contact Bruno Frank Dattilo, D.D.S. at 1-800-782-0181 with questions.

Affected Billing Codes

04341
04220
02950
02952
02954
02710
02720
02721
02722
02750
02751
02752
02790
02791
02792
03310
03320
03330
03410
03411
04210
04211
04260
04261
04262
04270
04271
04272