MedicaidBilling CodesHigh impact
Newsletter Vol. 4, No. 47
New Jersey Medicaid·NJ · Pediatrics, Family Medicine, General Practice·Provider Notice
We identified it
Jun 20, 2026
Summary
Federally Qualified Health Centers (FQHCs) must now use a new EPSDT encounter code W when billing for periodic preventive child health screening visits for Medicaid-eligible individuals under age 21. This change enables enhanced tracking and case management within the state's Medicaid system. The provider reimbursement rate remains unchanged, and managed care prior authorization policies stay in effect.
Action Required
Immediately: Billing team must update billing software and encounter forms to require use of the new EPSDT encounter code W for all periodic preventive child health screening visits (EPSDT visits) billed to Medicaid for patients under age 21. Providers must be trained to identify EPSDT screening visits and ensure this code is applied at time of billing. Submit claims using encounter code W within the required timeframe specified by your fiscal agent. Failure to use the correct encounter code may result in claims not being entered into the state's EPSDT tracking subsystem, which impacts case management services and program participation reporting.