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Newsletter Vol. 6, No. 30
Act
immediately
Effective date
Jul 1, 1996
Identified
Jun 20, 2026
Summary
New Jersey Medicaid now allows AIDS/HIV testing, STD testing, and related counseling to be billed as family planning services when provided in conjunction with a family planning encounter. Billing teams must complete specific claim form fields (HCFA 1500 Item 24H or UB-92 Condition Code A-4) and use designated HCPCS codes to identify these services for reimbursement eligibility.
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What to do
immediately · 7 steps
01Billing team must update all claim submission processes for New Jersey Medicaid to include family planning indicators when HIV/AIDS or STD testing is billed in conjunction with family planning visits.
02For HCFA 1500 claims, complete ITEM 24H with value code '2' (Family Planning Services) or '3' (Family Planning Services with EPSDT).
03For UB-92 claims, mark CONDITION CODE A-4 in FORM LOCATOR 24-30.
04Providers billing on HCFA 1500 must update templates and software to require this field completion.
05For HMO-enrolled beneficiaries under New Jersey Care 2000, ensure out-of-network family planning providers are reimbursed on fee-for-service basis per Medicaid requirements.
06When referring specimens to independent labs or hospital labs, notify the lab that testing should be flagged as a family planning service on their claim.
07When venipuncture is performed by a referring provider separate from testing lab, bill G0001 or 36415 for the draw; when both performed at same site, bill only the testing code.
If missed: Failure to properly identify these services with correct indicators will result in claim denials or rejections.
Codes mentioned
86311863598636086687866888668986701867028670383516835188625586256862878628986291862938629586592865938663186632866748669486695867298678187075870768711087164872058720787210872118722087250G000136415
Original notice
Newsletter Vol. 6, No. 30
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 9, No. 54HighEffective Oct 1, 1999 · CodingNewsletter Vol. 10, No. 02HighEffective Oct 1, 1999 · CodingNewsletter Vol. 23, No.09HighEffective Apr 1, 2013 · Provider NoticeNewsletter Vol. 10, No. 19MediumEffective Jun 1, 1998 · Medical PolicyBrowse every New Jersey Medicaid change in the policy list
Related policy hubs
New Jersey Medicaid policiesNJ policy changesOB-GYNFamily MedicineInternal MedicineInfectious DiseaseGeneral PracticePathologyCode 86311Code 86359Code 86360Code 86687Code 86688Code 86689Code 86701Code 86702Code 86703Code 83516Code 83518Code 86255Code 86256Code 86287Code 86289Code 86291Code 86293Code 86295Code 86592Code 86593Code 86631Code 86632Code 86674Code 86694Code 86695Code 86729Code 86781Code 87075Code 87076Code 87110Code 87164Code 87205Code 87207Code 87210Code 87211Code 87220Code 87250Code G0001Code 36415