MedicaidReimbursementHigh impact
Newsletter Vol. 4, No. 04
New Jersey Medicaid·NJ · Oncology, Family Medicine, Internal Medicine +2 more·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid will now directly reimburse physicians for administering specific drugs in their offices instead of requiring patients to get prescriptions from pharmacies. The policy includes specific procedure codes and reimbursement rates based on Average Wholesale Price (AWP) for injectable and inhalation drugs.
Action Required
By January 1, 2025: Billing team must update NJ Medicaid billing to use the specific HCPCS procedure codes listed in the newsletter for physician-administered drugs instead of having patients obtain prescriptions from pharmacies. Update billing system with new maximum fee allowances based on AWP pricing. Train staff that office visits solely for drug administration cannot be billed separately - only the drug and administration codes are reimbursable unless additional services meeting office visit criteria are provided.