MedicaidBilling CodesHigh impact
Newsletter Vol. 7, No. 40
New Jersey Medicaid·NJ · OB-GYN·Coding
Effective date
Jan 1, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has added new HCPCS procedure codes for Nurse Practitioners and Clinical Nurse Specialists effective January 1, 1997, including OB/GYN-specific codes (fetal non-stress tests, antepartum visits, postpartum care) and general codes (venipuncture, hepatitis B immunization). Additionally, the 'AV' modifier is now required when billing 12 specific cardiovascular and chemotherapy procedure codes.
Action Required
CRITICAL ALERT - POLICY DATE ISSUE: This policy is dated July 1997 but marked as 'recent' (1 month old). The effective date of January 1, 1997 is in the past. Verify policy authenticity and current applicability before implementation. If valid for current use: (1) Billing team must immediately update system master file to recognize codes 59025, 59430, W9855, W9856, G0001, and W9096 with corresponding fee amounts ($18.00, $17.10, $16.15, $13.30, $1.80, $2.50 respectively). (2) Configure billing software to automatically append 'AV' modifier to claims for codes 92950, 96400, 96408, 96410, 96412, 96414, 96420, 96422, 96423, 96425, 96520, and 96530 when submitted to NJ Medicaid fee-for-service. (3) Train NP/CNS providers and billing staff on new codes, particularly OB/GYN specialization requirements. (4) Ensure all claims are submitted within NJ Medicaid timely filing requirements (N.J.A.C. 10:49-7). (5) For NJ-based practices only: Contact Laura Gernhardt, R.N. at 609-588-2751 with questions. Failure to append required modifiers will result in claim denials or reduced reimbursement.