MedicaidBilling CodesMedium impact
Newsletter Vol. 6, No. 19
New Jersey Medicaid·NJ · Family Medicine, Pediatrics, General Practice·Provider Notice
Effective date
Jul 1, 1995
We identified it
Jun 20, 2026
Summary
This newsletter provides clarification on adolescent family planning services billing for FQHCs and Family Planning Clinics. Key points: HCPCS codes Y7633WF and Y7634WF are paid fee-for-service outside HMO managed care; Teen Directed Services must occur within 7 days of a Family Planning Clinic visit if both are provided; Y7634WF follow-up visits cannot be billed within 30 days of the initial visit; data reporting requirements will be implemented by the Department of Health.
Action Required
Billing team must implement the following procedures for Family Planning Clinics and FQHCs: (1) Ensure HCPCS codes Y7633WF (Initial/Annual Visit) and Y7634WF (Follow-Up Visit) are always billed fee-for-service for HMO-enrolled individuals, outside managed care requirements—update billing system rules to override HMO capitation for these codes. (2) In the billing system and encounter forms, establish validation rules to ensure Teen Directed Services are rendered within 7 days of a Family Planning Clinic visit when both services are provided on the same claim or related encounters. (3) Program billing software to block submission of Y7634WF (Follow-Up Visit) within 30 days of the initial teen directed visit; if medical services are needed during this period, bill appropriate medical service codes instead. (4) Prepare for future Department of Health data-reporting requirements—await written notification from DOH on implementation effective date and establish semi-annual reporting process to DOH. Failure to comply with the 7-day and 30-day timing rules will result in claim denials. Contact Deborah Bradley at (609) 588-7282 or Celeste Andriot-Wood at (609) 984-1384 with questions.