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Newsletter Vol. 4, No. 06
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Garden State Health Plan now permits separate HCPCS billing for tubal ligation or fallopian tube transection procedures performed concurrently with cesarean section or intra-abdominal surgery. Previously, these were considered inclusive to the primary procedure. Providers may now bill an additional HCPCS code for the tubal procedure; multiple surgery pricing does not apply.
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What to do
immediately · 4 steps
01Billing team must update coding guidelines and provider education materials to reflect that tubal ligation/transection procedures performed at time of cesarean section or intra-abdominal surgery are now separately billable with appropriate HCPCS codes.
02Ensure coders understand that multiple surgery pricing rules do NOT apply to this scenario.
03Verify all prior authorization requirements remain in effect per Garden State Health Plan policy.
04Update billing system templates and encounter forms for OB/GYN and general surgery providers to capture separate coding for concurrent tubal procedures.
Original notice
Newsletter Vol. 4, No. 06
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 4, No. 01MediumEffective Jul 1, 2024 · Provider NoticeNewsletter Vol. 4, No. 03LowNo effective date · CodingNewsletter Vol. 4, No. 04HighEffective Jan 1, 2025 · Provider NoticeNewsletter Vol. 4, No. 05MediumNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list