Reproductive Health

Fecha: 28/04/23

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