Summary
New Jersey Medicaid updated reimbursement rates for intrauterine device (IUD) insertion and removal procedures effective January 1, 1998. Billing teams must now use specific HCPCS codes (W0001, W0002, W0004, W0008, E58301) and mark claims with Family Planning indicator codes ("2" or "3" for EPSDT) in ITEM 24H on the HCFA 1500 form. Reimbursement rates vary by provider type (physician vs. certified nurse-midwife) and device type (Paragard vs. Progestasert).
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What to do
Action · 6 steps
01Before submitting claims for IUD services.
02Billing team must update billing software to recognize HCPCS codes W0001, W0002, W0004, W0008, and E58301 with their corresponding New Jersey Medicaid maximum fee allowances.
03Require providers to complete ITEM 24H on HCFA 1500 claims with code "2" for standard Family Planning Services or code "3" for EPSDT beneficiaries under age 21.
04Ensure correct codes are used based on procedure type (insertion vs. removal/reinsertion) and provider credential (physician vs. certified nurse-midwife).
05For any claims already paid at previous rates with dates of service on or after January 1, 1998, submit FD-999 Claims Adjustment Forms to request additional reimbursement.
06Train billing staff on new reimbursement schedule differentials between specialist and non-specialist providers.
If missed: Failure to use correct codes and family planning indicators will result in claim denials or underpayment.
Codes mentioned
W0001W0002W0004W000858301
Original notice
Newsletter Vol. 9, No. 15
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 9, No. 12MediumEffective Jan 1, 1998 · Provider NoticeNewsletter Vol. 9, No. 13MediumEffective Jan 1, 1998 · Provider NoticeNewsletter Vol. 9, No. 14MediumEffective Jan 1, 1998 · Provider NoticeNewsletter Vol. 12, No. 92HighEffective Sep 1, 2002 · CodingBrowse every New Jersey Medicaid change in the policy list