Summary
New Jersey Medicaid has added new HCPCS procedure codes and maximum fee allowances for prosthetic and orthotic services, deleted obsolete codes (X4800-X4805), and added new qualifiers to existing codes (L3001, L3010, L3020, L3030, L3040, L3050, L3060). Billing teams must update their coding systems and fee schedules to reflect these changes effective January 1, 1998.
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What to do
Action · 8 steps
01CRITICAL ISSUE: This policy is dated June 1998 with an effective date of January 1, 1998 — this is 26+ years old and likely already implemented.
02BEFORE 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.
03If this is your baseline policy.
04Billing 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).
05Replace all instances of deleted codes X4800, X4801, X4802, X4803, X4804, X4805 with their replacement codes (L3010, L3020, L3030) in billing rules and templates.
06Providers 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.
07Add new codes L0999, L1843, L2035, L5826, L8039, L8239 to the billing system with 'B.R.' (By Report) fee allowances.
08Contact the New Jersey Medicaid Prosthetic and Orthotic Consultant at (609) 588-2739 to confirm current fee schedules and any updates since 1998.
If missed: Failure to update coding and qualifiers will result in claim denials or incorrect reimbursement.
Codes mentioned
L0999L1843L2035L5826L8039L8239L3001L3010L3020L3030L3040L3050L3060X4800X4801X4802X4803X4804X4805
Original notice
Newsletter Vol. 8, No. 41
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Related policy hubs
New Jersey Medicaid policiesNJ policy changesOrthopedicsPhysical TherapyPodiatryPM&R (Physical Medicine & Rehab)Code L0999Code L1843Code L2035Code L5826Code L8039Code L8239Code L3001Code L3010Code L3020Code L3030Code L3040Code L3050Code L3060Code X4800Code X4801Code X4802Code X4803Code X4804Code X4805