MedicaidReimbursementMedium impact
Newsletter Vol. 8, No. 59
New Jersey Medicaid·NJ · Plastic Surgery, General Surgery, Wound Care·Coding
Effective date
Sep 1, 1998
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid corrected the maximum fee allowances for HCPCS codes L8000 (breast prosthesis, mastectomy bra) and L8030 (breast prosthesis, silicone or equal) from fixed amounts ($16.00 and $125.00) to "By Report" pricing. Providers must now submit Adjustment Claim Forms (FD-999s) with approved pricing documentation to request payment adjustments for previously denied or underpaid claims.
Action Required
Immediately: Billing team must update fee schedules and billing system to reflect that HCPCS codes L8000 and L8030 are now "By Report" pricing (not fixed fees). For any previously submitted claims for these codes that were denied or paid at the old fixed rates ($16.00 and $125.00 respectively), providers must submit completed Adjustment Claim Forms (FD-999s) with approved pricing documentation to Unisys to request payment adjustments. Update internal documentation and provider communications to reflect this change. Note: The corrected pricing has been retroactively in effect since June 5, 1997 (L8000) and January 1, 1994 (L8030).