MedicaidBilling CodesHigh impact
Newsletter Vol. 5, No. 18
New Jersey Medicaid·NJ · Dentistry, Pediatrics·Provider Notice
Effective date
Jan 15, 1995
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid introduces HCPCS code 00110 WT for comprehensive clinical oral examinations of children (birth through age 20) with enhanced reimbursement rates ($14–$18 depending on provider type). This code replaces standard code 00110 for pediatric exams and is limited to once every 6 months. Providers may retroactively adjust claims dating back to January 15, 1995.
Action Required
By January 15, 1995 (or immediately for any services already rendered on/after that date): (1) Billing team must update billing system to recognize and process HCPCS code 00110 WT for all pediatric comprehensive oral examinations for patients under age 21; (2) Implement frequency limit of once per 6 months in billing software to prevent duplicate claim submission; (3) Configure reimbursement rates: $14.00 for non-specialists, $18.00 for specialists; (4) Dental providers must verify patient age at time of service and ensure documentation includes all seven minimum examination components (oral observation, cancer screening, dental development assessment, charting, treatment plan, anticipatory guidance, caries/fluoride assessment); (5) For any services already billed with code 00110 on/after January 15, 1995, submit Adjustment Request Form (FD-999) with 'Claim Correction' indicated in block 4 and revised claim form attached to receive enhanced reimbursement; (6) Contact NJ Division of Medical Assistance and Health Services Bureau of Dental Services at (609) 588-7136 or 1-800-782-0181 with questions. Failure to bill correctly will result in underpayment or claim denials.