MedicaidBilling CodesMedium impact
Newsletter Vol. 10, No. 58
New Jersey Medicaid·NJ · Family Medicine, General Practice·Provider Notice
Effective date
Aug 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is establishing reimbursement guidelines for adult male-specific family planning services effective August 1, 2000. Billing teams must use three specific HCPCS codes with modifier WF (99201 WF for initial visits, 99211 WF for follow-ups, 99395 WF for annual visits) and complete the family planning indicator field on all claims. All service components must be rendered to qualify for reimbursement, and claims must include the appropriate family planning code indicator ("2" or "3") on HCFA 1500 forms or condition code A-4 on UB-92 forms.
Action Required
By August 1, 2000: Billing team must update billing software to recognize and process CPT codes 99201, 99211, and 99395 with modifier WF for male family planning services. (1) Configure system to enforce family planning indicator requirement—ITEM 24H on HCFA 1500 forms must be completed with code "2" (Family Planning Services) or "3" (Family Planning Services with EPSDT), and condition code A-4 must be indicated in FORM LOCATOR 24-30 on UB-92 forms. (2) Ensure billing system validates that all service components are documented before allowing claim submission—partial services will result in claim denials. (3) Update encounter forms and provider training materials to clarify that 99201 WF and 99395 WF can only be billed once per beneficiary (99201 WF once per fee-for-service beneficiary lifetime; 99395 WF once every 12 months). (4) Verify that signed "informed consent" forms are obtained and documented in patient records prior to any examination or treatment. (5) For HMO-enrolled beneficiaries, confirm system allows fee-for-service reimbursement when services are rendered by non-network providers who meet Medicaid/NJ KidCare requirements. Failure to include proper family planning indicators will result in claim denials.