MedicaidBilling CodesMedium impact
Newsletter Vol. 3, No. 22
New Jersey Medicaid·NJ · Family Medicine, OB-GYN·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated reimbursement policy for Norplant System (levonorgestrel subdermal implants) at independent clinics, establishing new HCPCS procedure codes, maximum fee allowances that include kit costs, and strict limits on coverage (maximum 2 insertions and 2 removals per 5-year period). Previous procedure codes are discontinued effective after July and claims using old codes will be denied.
Action Required
By the end of July (date of service cutoff): Billing team must discontinue use of old HCPCS procedure codes (identified as WWOF and WWOF variants in the prior policy) and transition to new codes listed in this newsletter for Norplant insertion, removal, and removal-with-reinsertion procedures. Update billing system and encounter forms to reflect new code set. Implement system edits to enforce the reimbursement limits: deny claims for more than 2 insertions and 2 removals within any 5-year continuous period, and deny claims combining NPS insertion/reinsertion with other contraceptive methods (e.g., IUD). Ensure maximum fee allowances in billing system include the direct package price of the NPS kit as specified. Claims with dates of service on or after July using discontinued codes will be denied. This change applies ONLY to independent clinics providing family planning services in New Jersey.