Newsletter Vol. 8, No. 41

CRITICAL ISSUE: This policy is dated June 1998 with an effective date of January 1, 1998 — this is 26+ years old and likely already implemented. BEFORE taking action, verify with your Medicaid billing system and the New Jersey Division of Medical Assistance & Health Services whether this newsletter reflects current coding requirements, as HCPCS codes and fee schedules are updated annually. If this is your baseline policy: (1) Billing team must immediately update the billing system fee schedule to reflect new maximum allowances for codes L1843 ($392.81), L3001 ($76.00), L3010 ($76.00), L3020 ($88.00), L3030 ($48.00), L3040 ($29.60), L3050 ($32.00), and L3060 ($48.00). (2) Replace all instances of deleted codes X4800, X4801, X4802, X4803, X4804, X4805 with their replacement codes (L3010, L3020, L3030) in billing rules and templates. (3) Providers and billers must add new qualifiers when selecting L3001, L3010, L3020, L3030, L3040, L3050, L3060 to distinguish between custom devices and off-the-shelf products. (4) Add new codes L0999, L1843, L2035, L5826, L8039, L8239 to the billing system with 'B.R.' (By Report) fee allowances. (5) Contact the New Jersey Medicaid Prosthetic and Orthotic Consultant at (609) 588-2739 to confirm current fee schedules and any updates since 1998. Failure to update coding and qualifiers will result in claim denials or incorrect reimbursement.