New Jersey Medicaid - also known as NJ FamilyCare - covers most kinds of addiction treatment, including outpatient, residential, and medical detox services. “Substance Use Disorder Treatment” in general is considered to be a “covered health care service” by New Jersey Department of Medical Assistance and Health Services. 

Today, we’ll look at five key pieces of information you should know if your addiction treatment organization accepts Medicaid patients.

Understand the Managed Care Organizations that Work With New Jersey Medicaid 

New Jersey Medicaid works with managed care organizations (MCOs) to manage the administration of health insurance for patients. This common set up means that there are several different insurance entities that ultimately represent Medicaid in New Jersey. 

When you’re working with these managed care organizations, you’ll encounter names like:

– Aetna Better Health of New Jersey 

– Amerigroup New Jersey, Inc.
– Horizon NJ Health
– UnitedHealthcare Community Plan, or  

– WellCare Health Plans of NJ, Inc. 

All of these organizations are associated with Medicaid patients in New Jersey. 

Be Timely With Your Claims to New Jersey Medicaid

New Jersey Medicaid has strict rules about the timeframe all providers must work within to submit a viable claim. Keep the claims flowing and don’t allow your billing department to get backed up. 

New Jersey Medicaid requires that: 

• All claims must be submitted within 180 calendar days of providing the service 

• All corrected claims must be submitted within 365 days

• All claims must be settled within 365 days.  

Always Check to be Sure that Addiction Treatment Patients are Current with Their Medicaid Coverage in New Jersey 

Many patients lost their Medicaid insurance coverage during the Medicaid unwinding process. New Jersey was no exception. Between April 1st, 2023 and August 31, 2023 some 130,000 men, women and children lost their insurance coverage. Many are still not aware that their status has changed.

For this reason, it’s more important than ever to verify patients’ insurance information before admission. 

Be Aware of the Rule Changes Around Buprenorphine and Medicaid in New Jersey

New Jersey Medicaid recently changed its rules to promote the use of buprenorphine as an alternative to methadone in medication assisted treatment settings. These rules came down in 2019 and are still in effect today. 

In order to expand access to this life-saving medicine, New Jersey opted to: 

• Drop all prior authorization requirements for buprenorphine prescriptions 

• Raise the reimbursement rate for addiction treatment 

• Establish regional “centers of excellence” for addiction treatment

Know Some of the Most Frequently Used CPT Codes When Billing Medicaid for Addiction Treatment Services in New Jersey 

Covered Services (or, “Payable Encounters”) for New Jersey Medicaid patients Include: 

90791uc - Comprehensive intake evaluation assessment 

90792uc - Comprehensive intake evaluation assessment with physician involvement 

90832uc - Individual psychotherapy - 20-30 minutes 

E and M 90833uc - individual psychotherapy - 20-30  minutes with medical evaluation and management 

90834uc - Individual psychotherapy - 45 minutes 

E and M + 90836uc - individual psychotherapy 45 minutes with medical evaluation and management 

90837uc - Individual psychotherapy - 60 minutes 

E and M + 90838uc - Individual psychotherapy - 60 minutes with medical evaluation and management 

90847uc - Special family therapy 

96105uc - Assessment of aphasia 

96111uc - Development test - extended 

9615)uc - Health and behavioral assessment, 15 minutes units, initial assessment 

96151uc - Health and behavioral re-assessment, 15 minutes, units 

96152uc - Health and behavioral intervention, individual, 15 minutes, units 

96154uc - Health and behavioral intervention, family and patient, 15 minutes, units 

9155uc - Health and behavioral intervention, family without patient, 15 minutes, units 

99201uc - Evaluation and management office visit new patient - approximately 10 minutes 

99202uc - Evaluation and management office visit new patient - approximately 20 minutes 

99203uc - Evaluation and management office visit new patient - approximately 30 minutes 

99204uc - Evaluation and management office visit new patient - approximately 45 minutes 

99205uc - Evaluation and management office visit new patient - approximately 60 minutes 

99211uc - Evaluation and management office visit - established patient - approximately 5 minutes 

99212uc - Evaluation and management office visit - established patient - approximately 10 minutes 

99213uc - Evaluation and management office visit - established patient - approximately 15 minutes 

99214uc - Evaluation and management office visit - established patient - approximately 25 minutes 

99215uc - Evaluation and management office visit - established patient - approximately 40 minutes 

H2011uc - Off site crisis intervention 

90832HF - Psychotherapy rendered in drug court - half session

90834HF - Psychotherapy rendered in drug court - full session 

90847HF - Special family therapy 

99201HF - Prescription visit rendered in drug treatment center 

99211HF - Prescription visit rendered in drug treatment center

H0003HF - Urine analysis for drug addiction

New Jersey Medicaid Billing Made Easier 

Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers.

Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!