Summary
New Jersey Medicaid and NJ KidCare now reimburse for specific laboratory and office visit codes related to elective abortion services. Providers must use designated HCPCS codes with modifier 'YD' for lab work and office visits; office visit codes can only be billed once per procedure regardless of multiple visits. Providers must resubmit unpaid claims retroactive to June 1, 1998 with proof of timely filing for reimbursement.
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What to do
Action · 4 steps
01By the date of claim submission: Billing team must update coding practices to use HCPCS codes with modifier 'YD' for all laboratory services (G0001, 36415, 80051, 80055, 80100, 81000, 81002, 81025, 82947, 84702, 84703, 85014, 85022, 85024, 85025, 85610, 85730, 86592, 86762, 86850, 86900, 86901, 87340) and office visit codes (99203, 99213) related to elective abortion services for NJ Medicaid and NJ KidCare beneficiaries.
02Ensure office visit codes are billed only once per procedure, even if multiple visits occur.
03Immediately: Identify and resubmit all unpaid claims with dates of service on or after June 1, 1998 with proof of timely filing to recover retroactive reimbursement.
04Update billing software to enforce single billing of office visit codes per procedure and apply modifier 'YD' automatically for qualifying abortion-related lab and office visit claims.
If missed: Failure to use correct codes and modifiers will result in claim denials.
Codes mentioned
G0001364158005180055801008100081002810258294784702847038501485022850248502585610857308659286762868508690086901873409920399213
Original notice
Newsletter Vol. 10, No. 19
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 13, No. 29MediumEffective Jan 1, 2003 · CodingNewsletter Vol. 6, No. 30HighEffective Jul 1, 1996 · Provider NoticeNewsletter Vol. 12, No. 74HighEffective Sep 16, 2002 · Provider NoticeNewsletter Vol. 13, No. 06HighEffective Sep 16, 2002 · Provider NoticeBrowse every New Jersey Medicaid change in the policy list
Related policy hubs
New Jersey Medicaid policiesNJ policy changesOB-GYNGeneral PracticeFamily MedicineCode G0001Code 36415Code 80051Code 80055Code 80100Code 81000Code 81002Code 81025Code 82947Code 84702Code 84703Code 85014Code 85022Code 85024Code 85025Code 85610Code 85730Code 86592Code 86762Code 86850Code 86900Code 86901Code 87340Code 99203Code 99213