MedicaidReimbursementMedium impact
Newsletter Vol. 2, No. 47
New Jersey Medicaid·NJ · Pathology·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid changed its reimbursement methodology for hospital outpatient laboratory/pathology services, implementing a new fee schedule instead of using Medicare Part A rates. The new rates will be comparable to amounts paid to independent clinical laboratories for the same services.
Action Required
Hospitals billing New Jersey Medicaid must obtain and implement the new HCPCS fee schedule from the Hospital Outpatient Laboratory Services Subchapter. Contact Phyllis Valeri-Bruschini or Jeffrey Campbell for the updated fee schedule and update billing systems with new reimbursement rates. Note that some HCPCS codes will continue using cost-to-charge ratios (marked as SCC).