MedicaidBilling CodesHigh impact
Newsletter Vol. 2, No. 01
New Jersey Medicaid·NJ · Wound Care, General Practice, Urology·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has assigned unit price maximum fee allowances to 11 HCPCS codes for medical supplies (primarily ostomy and incontinence products). Billing teams must now enter the NUMBER OF UNITS DISPENSED in Field F of NJ claim forms, not packages/boxes/cases, to ensure correct pricing and expedite claim processing.
Action Required
By January 1, 2025: Billing team must update all claim submission processes to enter UNITS DISPENSED (not packages/boxes/cases) in Field F for the 11 assigned HCPCS codes (A4218, X-series ostomy/incontinence codes). Update billing software validation rules to reject claims with package/box quantities for these codes. Train all billing staff on the distinction—for example, a package containing 30 diapers = 30 units in Field F, NOT 1 package. Ensure NJ claim forms comply with the Fiscal Agent Billing Supplement requirements. Failure to enter correct unit quantities will result in incorrect claim pricing and potential denials or payment adjustments.