MedicaidPrior AuthHigh impact
Newsletter Vol. 10, No. 85
New Jersey Medicaid·NJ · General Surgery, Orthopedics, Neurosurgery +2 more·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ KidCare-Plan A now require second surgical opinions for specific elective procedures including hysterectomy, spinal fusion, laminectomy, and hernia repair (with age restrictions). Claims must include FD-263 forms unless surgery is urgent/emergent or geographically waived.
Action Required
Immediately: Billing team must update system to flag all listed elective procedure codes for NJ Medicaid/KidCare patients to require FD-263 Second Surgical Opinion form before submission. Train staff to verify second opinion completion via 1-800-676-6562 *3. Submit hard copy claims with FD-263 attached. For urgent/emergent cases, attach physician attestation statement instead of FD-263. Claims without proper documentation will be denied.