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New Jersey MedicaidMedicaid · Reimbursement · Provider Notice · NJ · Oncology, Family Medicine, Internal Medicine +2 moreHigh impact

Newsletter Vol. 4, No. 04

Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Jun 20, 2026

Summary

New Jersey Medicaid will now directly reimburse physicians for administering specific drugs in their offices instead of requiring patients to get prescriptions from pharmacies. The policy includes specific procedure codes and reimbursement rates based on Average Wholesale Price (AWP) for injectable and inhalation drugs.

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What to do

by Jan 1, 2025 · 3 steps
01Billing team must update NJ Medicaid billing to use the specific HCPCS procedure codes listed in the newsletter for physician-administered drugs instead of having patients obtain prescriptions from pharmacies.
02Update billing system with new maximum fee allowances based on AWP pricing.
03Train staff that office visits solely for drug administration cannot be billed separately - only the drug and administration codes are reimbursable unless additional services meeting office visit criteria are provided.

Codes mentioned

J0690J0696J1100J1200J2550J2680J9000J9001J9019J9031J9040J9045J9055J9070J9080J9130J9185J9202J9230J9291J9300J9360J9390J9370J7194J9218J1950J1951J1952

Original notice

Newsletter Vol. 4, No. 04
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 12, No. 81MediumEffective Jan 1, 2002 · Provider NoticeNewsletter Vol. 10, No. 68MediumEffective Oct 1, 2000 · Provider NoticeNewsletter Vol. 14, No. 31HighEffective Apr 1, 2004 · Provider NoticeNewsletter Vol. 19, No. 18HighEffective Jun 8, 2009 · PharmacyBrowse every New Jersey Medicaid change in the policy list

Related policy hubs

New Jersey Medicaid policiesNJ policy changesOncologyFamily MedicineInternal MedicineGeneral PracticeEndocrinologyCode J0690Code J0696Code J1100Code J1200Code J2550Code J2680Code J9000Code J9001Code J9019Code J9031Code J9040Code J9045Code J9055Code J9070Code J9080Code J9130Code J9185Code J9202Code J9230Code J9291Code J9300Code J9360Code J9390Code J9370Code J7194Code J9218Code J1950Code J1951Code J1952

Summaries are AI-assisted. Always confirm against the original payer notice.

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