News
Reproductive Health
Date: 04/28/23
Thank you for being an Ambetter from WellCare of New Jersey provider. We are committed to providing quality communication with an excellent provider and member experience.
The New Jersey Department of Banking and Insurance recently made updates to the rules at N.J.A.C. 11:24A-1.1 and a new subchapter in N.J.A.C. 11:24A. Effective on January 1, 2023, this new rule will implement the Freedom of Reproductive Choice Act, P.L. 2021, c. 375. This means that there are changes to member benefits. Some examples include increased coverage for reproductive health services and removal of some age requirements for hearing aids.
Member Explanation of Coverage (EOC) and current policy amendments can be found under “Plan Brochures & Summaries of Benefits & Coverage” at the following website: ambetter.wellcarenewjersey.com
We thank you for your commitment to the care and wellbeing of our members, and to the communities we serve. Should you have any questions or concerns about this notification, please contact Provider Services at 1-844-606-1926. Policies are posted on our website at ambetter.wellcarenewjersey.com.
Modified Codes for Reproductive Health
elective abortion: use DX 233.2 no mod or condition code needed
abortion due to rape: use condition code AA and modifier G7
DX codes: Z69020, Z69021, Z69021, Z6911, Z6911, Z6912, Z6912, Z6981, Z6981, Z6982, Z6982
abortion due to incest: use condition code AB and modifier G7
DX codes: Z69010, Z69011
abortion due to life of mother threatened: use condition code AD or AF and modifier G7
DX codes: N96, O00, O0000, O001, O0010, O00101, O00102, O00109, O0011, O00111, O00112, O00119, O002, O0020, O00201, O00202, O00209, O0021, O00211, O00212, O00219, O008, O0080, O0081, O009, O0090, O0091, O01, O010, O011, O019, O02, O020, O021, O028, O03, O030, O031, O0330, O0331, O0332, O0333, O0334, O0335, O0336, O0337, O0338, O0339, O034, O035, O036, O037, O0380, O0381, O0382, O0383, O0384, O0385, O0386, O0387, O0388, O0389, O039, O04, O045, O046, O047, O0480, O0481, O0482, O0483, O0484, O0485, O0486, O0487, O0488, O0489, O07, O070, O071, O072, O073, O0730, O0731, O0732, O0733, O0734, O0735, O0736, O0737, O0738, O0739, O074, O08, O200, O364, O759, P95, Z331
abortion due to futile pregnancy: use condition code AC and modifier G7
DX codes: D392, E833, G318, G935, O3620, O3620X0, O3620X1, O3620X3, O3620X4, O3620X5, O3620X9, Q000, Q001, Q002, Q042, Q248, Q430, Q601, Q770, Q771, Q772, Q773, Q774, Q775, Q776, Q777, Q778, Q779, Q780, Q870, Q871, Q872, Q873, Q874, Q875, Q878, Q897, Q910, Q911, Q912, Q913, Q914, Q915, Q916, Q917, Q920, Q921, Q922, Q925, Q926, Q927, Q928, Q929
abortion procedure codes: 59414, 59812, 59820, 59821, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, S0190, S0199