New Jersey MedicaidMedicaid · Prior Auth · Provider Notice · NJ · General Surgery, Orthopedics, Neurosurgery +2 moreHigh impact

Newsletter Vol. 10, No. 85

Q: Who is affected by this change?

This affects New Jersey Medicaid General Surgery, Orthopedics, Neurosurgery, OB-GYN, ENT (Ear, Nose & Throat) providers in NJ on Medicaid plans.

Q: What do I need to do?

Immediately: Billing team must update system to flag all listed elective procedure codes for NJ Medicaid/KidCare patients to require FD-263 Second Surgical Opinion form before submission. Train staff to verify second opinion completion via 1-800-676-6562 *3. Submit hard copy claims with FD-263 attached. For urgent/emergent cases, attach physician attestation statement instead of FD-263. Claims without proper documentation will be denied.

Q: Which billing codes are affected?

The following codes are affected: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58550, 58551, 22548, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22800, 22802, 22804, 22808, 22810, 22812, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63045, 63046, 63047, 63048, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63170, 63172, 63173, 63180, 63182, 63185, 63190, 63191, 63194, 63195, 63196, 63197, 63198, 63199, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 49505, 49520, 49525, 49550, 49555, 49560, 49565, 49570, 49585, 49590, 49650, 49651, 56316, 56317.

Act

immediately

Effective date

Not stated in the notice

Identified

Jun 20, 2026

Summary

New Jersey Medicaid and NJ KidCare-Plan A now require second surgical opinions for specific elective procedures including hysterectomy, spinal fusion, laminectomy, and hernia repair (with age restrictions). Claims must include FD-263 forms unless surgery is urgent/emergent or geographically waived.

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What to do

immediately · 5 steps

01Billing team must update system to flag all listed elective procedure codes for NJ Medicaid/KidCare patients to require FD-263 Second Surgical Opinion form before submission.

02Train staff to verify second opinion completion via 1-800-676-6562 *3.

03Submit hard copy claims with FD-263 attached.

04For urgent/emergent cases, attach physician attestation statement instead of FD-263.

05Claims without proper documentation will be denied.

Codes mentioned

5815058152581805826058262582635826758270582755828058550585512254822554225562255822585225902259522600226102261222614226302263222800228022280422808228102281222830228402284122842228432284422845228462284722848228496300163003630056301163012630156301663017630206303063035630406304263045630466304763048630556305663057630646306663075630766307763078630816308263085630866308763088630906309163170631726317363180631826318563190631916319463195631966319763198631996320063250632516325263265632666326763268632706327163272632734950549520495254955049555495604956549570495854959049650496515631656317

Original notice

Newsletter Vol. 10, No. 85

njmmis.com · Always check the source before changing claims.

View original ↗

Related changes

See all New Jersey Medicaid changes →

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Related policy hubs

New Jersey Medicaid policies NJ policy changes General Surgery Orthopedics Neurosurgery OB-GYN ENT (Ear, Nose & Throat)Code 58150 Code 58152 Code 58180 Code 58260 Code 58262 Code 58263 Code 58267 Code 58270 Code 58275 Code 58280 Code 58550 Code 58551 Code 22548 Code 22554 Code 22556 Code 22558 Code 22585 Code 22590 Code 22595 Code 22600 Code 22610 Code 22612 Code 22614 Code 22630 Code 22632 Code 22800 Code 22802 Code 22804 Code 22808 Code 22810 Code 22812 Code 22830 Code 22840 Code 22841 Code 22842 Code 22843 Code 22844 Code 22845 Code 22846 Code 22847 Code 22848 Code 22849 Code 63001 Code 63003 Code 63005 Code 63011 Code 63012 Code 63015 Code 63016 Code 63017 Code 63020 Code 63030 Code 63035 Code 63040 Code 63042 Code 63045 Code 63046 Code 63047 Code 63048 Code 63055 Code 63056 Code 63057 Code 63064 Code 63066 Code 63075 Code 63076 Code 63077 Code 63078 Code 63081 Code 63082 Code 63085 Code 63086 Code 63087 Code 63088 Code 63090 Code 63091 Code 63170 Code 63172 Code 63173 Code 63180 Code 63182 Code 63185 Code 63190 Code 63191 Code 63194 Code 63195 Code 63196 Code 63197 Code 63198 Code 63199 Code 63200 Code 63250 Code 63251 Code 63252 Code 63265 Code 63266 Code 63267 Code 63268 Code 63270 Code 63271 Code 63272 Code 63273 Code 49505 Code 49520 Code 49525 Code 49550 Code 49555 Code 49560 Code 49565 Code 49570 Code 49585 Code 49590 Code 49650 Code 49651 Code 56316 Code 56317

Newsletter Vol. 10, No. 85

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

Related changes

Related policy hubs

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