Summary
New Jersey Medicaid and NJ KidCare reduced maximum fee allowances for 21 specified HCPCS laboratory service codes, effective October 1, 1999, to align with Medicare fee reductions. Billing teams must update their fee schedules and billing systems to reflect the new lower reimbursement amounts for affected laboratory tests.
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What to do
Action · 5 steps
01Effective October 1, 1999: Billing team must immediately update all fee schedules and billing system rates for the 19 affected HCPCS laboratory codes to reflect the new reduced maximum allowances listed in the policy attachment.
02For claims with service dates on or after October 1, 1999, bill using the new fee amounts; continue using old rates only for claims with service dates prior to October 1, 1999.
03File the policy attachment in the Laboratory Services Manual (subchapter 3 for laboratories, subchapter 6 for clinics, or subchapter 9 for physicians) for staff reference.
04Verify that billing software is configured with correct rates to prevent underbilling or overbilling.
05Contact the Chief Laboratory Consultant at (609) 588-2751 with questions.
Codes mentioned
82017821368213982379830138301483080838918389383897839018390383905839068415484376843778826488291
Original notice
Newsletter Vol. 9, No. 75
njmmis.com · Always check the source before changing claims.