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Newsletter Vol. 4, No. 01
Act
by Jul 1, 2024 or upon first Depo-Provera claim
Effective date
Jul 1, 2024
Identified
Jun 20, 2026
Summary
New Jersey Medicaid establishes reimbursement for Depo-Provera Contraceptive Injection using a new HCPCS code, reimbursed at the lower of Average Wholesale Price (AWP) or acquisition cost. Providers may also bill separately for office visit and injection administration charges. This policy applies to physicians and independent clinics providing this service to Medicaid recipients.
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What to do
by Jul 1, 2024 or upon first Depo-Provera claim · 4 steps
01Billing team must update billing system to include HCPCS code J7171 for medroxyprogesterone acetate injection reimbursement.
02Configure system to apply the lower of AWP or acquisition cost for reimbursement.
03Ensure providers and billers understand that office visit and administration charges (code 90772) may be billed separately.
04Verify Garden State Health Plan prior authorization policies remain in effect and update encounter forms as needed.
If missed: Failure to use correct codes and apply proper reimbursement method will result in claim denials or underpayment.
Codes mentioned
J717190772
Original notice
Newsletter Vol. 4, No. 01
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 4, No. 03LowNo effective date · CodingNewsletter Vol. 4, No. 04HighEffective Jan 1, 2025 · Provider NoticeNewsletter Vol. 4, No. 05MediumNo effective date · Provider NoticeNewsletter Vol. 4, No. 06MediumNo effective date · CodingBrowse every New Jersey Medicaid change in the policy list