MedicaidBilling CodesMedium impact
Newsletter Vol. 5, No. 49
New Jersey Medicaid·NJ · Family Medicine, Pediatrics·Provider Notice
Effective date
Jul 1, 1995
We identified it
Jun 20, 2026
Summary
New HCPCS codes Y7633 WF and Y7634 WF are established for reimbursement of adolescent family planning services for Medicaid recipients under age 21 at Family Planning Clinics and Federally Qualified Health Centers. Y7633 covers initial/annual comprehensive services at $50 maximum; Y7634 covers follow-up visits at $25 maximum. Billing team must implement these new codes in their system and ensure providers understand billing limitations and comprehensive service requirements.
Action Required
By effective date (July 1, 1995, or immediately if services are already being rendered): (1) Billing team must add HCPCS codes Y7633 WF (max fee $50) and Y7634 WF (max fee $25) to billing system for Family Planning Clinics and FQHCs only. (2) Update billing software to enforce billing qualifiers: Y7633 can be billed once per 12-month period per Medicaid recipient under 21; Y7634 can be billed with family planning follow-up visits. (3) Billing staff must verify that providers document ALL required service components before submitting claims—incomplete documentation will result in denial. (4) Providers must agree to meet DOH reporting requirements: quarterly pregnancy reports, pregnancy outcome tracking, birth control method tracking, STD diagnosis tracking, and outreach activity reporting. (5) Update intake and encounter forms to capture comprehensive service elements required (risk assessment, contraceptive education, health education, care management). Claims lacking documented completion of all required components will be denied.