MedicaidCoverageMedium impact
Newsletter Vol. 8, No. 37
New Jersey Medicaid·NJ · Orthopedics, Rheumatology, Pain Management +1 more·Medical Policy
Effective date
Jul 1, 1998
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid will now reimburse for viscosupplementation injections (Synvisc and Hyalgan) for osteoarthritis of the knee treatment, effective immediately. Billing teams must update systems to recognize HCPCS codes W9348 and W9349 with specific reimbursement rates and injection limits, and ensure proper documentation of E/M services when applicable.
Action Required
Immediately: Billing team must add HCPCS codes W9348 (Synvisc, $206.56 per injection, limit 3 doses per cycle per knee) and W9349 (Hyalgan, $127.12 per injection, limit 5 injections per cycle per knee) to the billing system for New Jersey Medicaid claims. Update claim submission rules to enforce the 6-month treatment cycle limits and injection frequency restrictions. Providers must ensure that CPT 20610 (aspiration/injection, $13.00) is billed alongside the viscosupplementation codes. Verify that E/M office visit codes are only billed when separately identifiable E/M services are rendered and clearly documented in the medical record. Update encounter forms and clinical templates to capture required documentation. Failure to apply correct limits and billing combinations will result in claim denials or recoupment.