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Newsletter Vol. 2, No. 01
Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
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.
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What to do
by Jan 1, 2025 · 4 steps
01Billing 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).
02Update billing software validation rules to reject claims with package/box quantities for these codes.
03Train all billing staff on the distinction—for example, a package containing 30 diapers = 30 units in Field F, NOT 1 package.
04Ensure NJ claim forms comply with the Fiscal Agent Billing Supplement requirements.
If missed: Failure to enter correct unit quantities will result in incorrect claim pricing and potential denials or payment adjustments.
Codes mentioned
A4218X0001X0002X0003X0004X0005X0006X0007X0008X0009X0010
Original notice
Newsletter Vol. 2, No. 01
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 2, No. 02HighEffective Jan 1, 2024 · ReimbursementNewsletter Vol. 2, No. 03MediumNo effective date · CodingNewsletter Vol. 2, No. 04HighEffective Dec 1, 1991 · Provider NoticeNewsletter Vol. 2, No. 05LowNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list