MedicaidPrior AuthHigh impact
Newsletter Vol. 2, No. 34
New Jersey Medicaid·NJ · Orthopedics, Podiatry, Physical Therapy·Prior Authorization
We identified it
Jun 20, 2026
Summary
This policy establishes prior authorization requirements for prosthetic and orthotic services in New Jersey Medicaid, effective immediately. All prosthetic appliances (except preparatory temporary prostheses), all orthotic appliances, and all labor charges for repairs/replacements above specified thresholds now require prior authorization using the FD form with a prescription. Requests must be submitted to the appropriate Medicaid District Office (MDO), with orthopedic footwear and foot orthotic appliances routed to the Podiatric Consultant Division.
Action Required
Immediately: Billing team must implement prior authorization workflow for all prosthetic and orthotic claims in New Jersey Medicaid. (1) Stop submitting prosthetic appliance claims without prior authorization using the FD form (exceptions: preparatory temporary upper and lower prostheses below the specified charge threshold). (2) Require prior authorization for all orthotic appliances above the specified charge threshold. (3) Require prior authorization for all labor charges for repairs and/or replacement of prosthetic/orthotic parts above the specified charge threshold, except in emergencies. (4) Ensure RP modifier is appended to indicate repair and/or replacement of prosthetic and orthotic devices. (5) Route orthopedic footwear and foot orthotic appliance requests to the Podiatric Consultant Division at the specified New Jersey address. (6) Route all other prosthetic and orthotic prior authorization requests to the appropriate Medicaid District Office (MDO). (7) Update billing system to enforce these requirements and flag non-compliant claims. (8) Train providers and front desk staff on new submission requirements and routing instructions. Failure to obtain prior authorization will result in claim denials.