MedicaidBilling CodesHigh impact
Newsletter Vol. 5, No. 11
New Jersey Medicaid·NJ · Psychiatry, General Practice·Coding
Effective date
Apr 1, 1995
We identified it
Jun 20, 2026
Summary
Effective April 1, 1995, all personal care assistant services billing must convert from hourly procedure codes to half-hour codes, with rates set at half the hourly rate. Providers must not span calendar months when billing, and mental health clients are limited to 8 hours of personal care services per day. All previous hourly codes (Z1600, Z1614, Z1605, Z1616, Z1600ZI, Z1605ZI) become non-payable.
Action Required
By April 1, 1995: (1) Billing team must update billing system to REJECT all hourly personal care codes (Z1600, Z1614, Z1605, Z1616, Z1600ZI, Z1605ZI) as non-payable; (2) Reconfigure system to REQUIRE billing in half-hour intervals using only Z1611, Z1615, Z1612, Z1617, Z1611ZI, Z1612ZI codes; (3) Update rate tables to reflect half-hour rates (half of previous hourly rates); (4) Modify billing logic to PREVENT spanning service dates across calendar months—split claims by month; (5) For DMHS mental health contracts, implement system edit to LIMIT personal care services to 8 hours per day and 25 hours per week maximum; (6) Train all billing staff and providers on new half-hour conversion requirements (Example: 6 hours = 12 half-hour units). Claims submitted with old hourly codes after April 1 will be denied. Update provider manuals and claim submission instructions immediately.