MedicaidCoverageHigh impact
Newsletter Vol. 4, No. 60
New Jersey Medicaid·NJ · Radiology, General Practice, Family Medicine +2 more·Provider Notice
Effective date
Oct 1, 1999
We identified it
Jun 20, 2026
Summary
Effective October 1, New Jersey Medicaid is suspending payment for all mammography service claims until providers submit FDA certification or provisional certification documentation to the Medicaid fiscal agent (Unisys). Certified providers may bill for global fee or technical component (TC modifier), while independent physicians may bill only the professional component (PC modifier). HMOs must ensure their mammography providers meet FDA certification requirements.
Action Required
Effective October 1, 1999: (1) Billing team must immediately identify all providers offering mammography services (screening and diagnostic). (2) Obtain FDA certification or provisional certification documentation from each mammography provider. (3) Submit original or copy of FDA certification to Unisys Corporation, Provider Enrollment Unit, PO Box [address], Trenton, New Jersey before submitting any mammography claims to New Jersey Medicaid. (4) Update billing system to apply correct modifiers: TC (technical component) or global fee for certified facility providers; PC (professional component) ONLY for independent physician billers. (5) HMO contracts must require mammography providers to provide proof of FDA certification. Consequence: All mammography claims submitted without prior notification of FDA certification will be suspended/denied by New Jersey Medicaid until certification documentation is received by Unisys.