New Jersey Medicaid Fee Schedule 2026: Rates, Updates & Provider Guide

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against NJMMIS, DMAHS, and CMS official sources | Last Updated: March 2026

The New Jersey Medicaid fee schedule for 2026 is a mix of confirmed active rates and proposed changes still moving through the state legislature.

There is no single “2026 Master Fee Schedule” document — rates vary by provider type and are updated throughout the year.

This guide covers what is confirmed, what is pending, and exactly how to find the official rate files.

Quick Summary:

• NJ Medicaid (NJ FamilyCare) uses a fee-for-service (FFS) model for many provider types
• Confirmed 2026 rates exist for home health, hospital outpatient, and private duty nursing
• Several bills propose major rate increases for primary care, dental, and pediatric nursing
• Full fee schedules (CPT/HCPCS codes) are published on NJMMIS.com
• Income limits and eligibility rules are separate from provider rates
• Use our Medicaid Fee Schedule 2026 guide to compare rates across programs

What Is the NJ Medicaid Fee Schedule?

The NJ Medicaid fee schedule is a list of reimbursement rates paid to healthcare providers who serve NJ FamilyCare members.

It tells doctors, clinics, and other providers exactly how much the state will pay for each service.

Rates are set by the New Jersey Division of Medical Assistance and Health Services (DMAHS) and must be approved by the Centers for Medicare & Medicaid Services (CMS).

New Jersey does not publish one single master document. Instead, rates are organized by provider type and updated on a rolling basis throughout the fiscal year.

Status of the NJ Medicaid Fee Schedule for 2026

The 2026 fee schedule is currently active for some provider categories and still being finalized for others. The state fiscal year runs from July 1, 2025 through June 30, 2026, which means many approved rates are already in effect.

Federal Medicaid payment transparency rules require states to publish complete FFS rate schedules online by July 1, 2026 — New Jersey is still working toward full compliance.

Understanding the difference between confirmed rates and pending proposals will help providers and advocates plan ahead.

What “Confirmed” Means

A confirmed rate has been federally approved by CMS or is currently in active use by the state’s fiscal agent, NJMMIS. These are the rates providers can bill against right now.

What “Pending” Means

Pending rates are part of bills introduced in the 2026–2027 NJ Legislative Session. They have not been signed into law yet.

Providers should monitor these closely, as several proposals would significantly increase reimbursement.

Confirmed Rates Active for 2026

Several reimbursement structures are federally approved and currently in effect for the FY2026 period.

These come directly from CMS approval letters, NJMMIS rate tables, and DMAHS guidance documents.

Hospital Outpatient Services (State Directed Payments)

New Jersey uses an approved “State Directed Payment” model to bridge the gap between base Medicaid rates and actual costs for hospital outpatient departments.

• Public Facilities: Average add-on of approximately $956.80 per outpatient visit
• Private Facilities: Average add-on of approximately $212.55 per outpatient visit

Source: CMS Approval Letter for NJ State Directed Payments

Home Health Agency Statewide Rates (2026)

These rates are published on the official NJMMIS provider rate page and are currently active.

Source: NJMMIS Statewide Rates Table — njmmis.com

Private Duty Nursing (Current Rates)

While legislation is pending to raise these rates (see below), the current operational rates cited in FY2026 budget discussions are:

• Registered Nurse (RN): $61.00 per hour
• Licensed Practical Nurse (LPN): $49.00 per hour

Source: NJ Legislature Bill A3476 Context Section

Community-Based Palliative Care (Effective April 1, 2026)

DMAHS published minimum reimbursement rates for the Community-Based Palliative Care (CBPC) benefit effective April 1, 2026. These are floor rates — Managed Care Organizations (MCOs) must pay at or above these amounts.

• Initial Assessment: Minimum $100 (FFS rate)
• Per-Member-Per-Month (PMPM) Bundle: Minimum $686 (FFS rate)

Source: DMAHS MCO and Provider Guidance Packet, published January 29, 2026

Medical & Dental School Affiliates

Providers affiliated with New Jersey medical or dental schools receive a specific minimum fee schedule approved through June 30, 2026. This higher reimbursement level is designed to support teaching institutions that serve a high volume of Medicaid patients.

Source: CMS Managed Care Approval

Pending Rate Changes: 2026 Legislative Proposals

Several bills introduced in the 2026–2027 Legislative Session propose significant increases to Medicaid reimbursement rates. These are not yet law, but they show where rates may move later in the year.

Providers and advocates should track these bills closely through the NJ Legislature website.

If the primary care bill (S3802/A4265) passes, it would mark one of the largest Medicaid rate increases in New Jersey in years. Matching Medicare Part B rates would improve access to care and provider participation statewide.

How to Access the Official NJ Medicaid Fee Schedule Files

The full, granular fee schedule — listing thousands of CPT and HCPCS procedure codes with specific dollar amounts — is not published as a simple webpage. You must download the files directly from NJMMIS.

Here are the steps:

1. Go to: NJMMIS.com — the official New Jersey Medicaid Management Information System
2. Navigate to: “Rate and Code Information” or “Downloads” in the left sidebar
3. Look for: Files labeled “Fee Schedule” or “Exhibit 1” — these are updated monthly
4. For Physicians: Find the file titled “Physician Fee Schedule” under the “Agreed Upon Procedures” or “Exhibits” section
5. Check Newsletters: Go to the NJMMIS Newsletters section and look for “Vol. 36” (the 2026 series) for immediate alerts on rate changes

Tip: CMS has also approved two fee schedules covering part of 2026 — the primary care schedule and outpatient hospital renewal schedule — both valid from July 1, 2025 through June 30, 2026. These approvals can be found at Medicaid.gov state resources.

Who Qualifies for NJ Medicaid (NJ FamilyCare) in 2026?

Provider rates are one side of the equation. The other side is knowing which patients are eligible to be served under NJ Medicaid. Understanding New Jersey Medicaid eligibility in 2026 helps providers anticipate their patient population and billing volume.

NJ FamilyCare covers several groups, including:

• Adults ages 19–64 with income up to 138% of the Federal Poverty Level (FPL)
• Children and pregnant women (at higher income thresholds)
• Seniors and people with disabilities (with different income and asset rules)
• Long-term care applicants (with stricter financial criteria)

Eligibility is based on Modified Adjusted Gross Income (MAGI) for most groups, with asset limit rules applied separately for long-term care.

NJ Medicaid Income Limits for 2026

Income limits directly affect how many residents can access NJ FamilyCare — and in turn, how large a provider’s Medicaid patient panel can be. For a full breakdown by household size and program type, see our guide on New Jersey Medicaid income limits in 2026.

Key Income & Asset Figures for 2026

Source: Rothkoff Law Group / NJ Medicaid 2026 Figures; Medicaid.gov

These figures apply to applicants — not to provider reimbursement. However, they determine which patients are eligible to be billed under NJ Medicaid FFS or managed care.

How NJ Medicaid Pays Providers: FFS vs. Managed Care

Most NJ Medicaid members are enrolled in managed care organizations (MCOs) — not traditional fee-for-service. This means providers are often paid by the MCO, not directly by the state. The published fee schedule sets the minimum floor for what MCOs must pay in many cases.

For a broader national comparison of how states set Medicaid rates, see our guide on Medicaid income limits by state in 2026, which also covers how FPL thresholds interact with provider payment structures across the country.

Under fee-for-service, DMAHS pays providers directly per claim. Under managed care, each MCO negotiates rates — but must meet or exceed the state FFS floor for many services, such as the CBPC rates confirmed above.

FAQ

Sources & Disclaimer

Sources:

• New Jersey Medicaid Management Information System (NJMMIS): njmmis.com
• NJ Division of Medical Assistance and Health Services (DMAHS): nj.gov/humanservices/dmahs
• Centers for Medicare & Medicaid Services (CMS): medicaid.gov
• DMAHS CBPC Guidance Packet (January 29, 2026): nj.gov/humanservices/dmahs/info/NJ_CBPC_Program_Guidance.pdf

Last Updated: March 2026

Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official provider rate information, contact DMAHS directly or visit NJMMIS.com and Medicaid.gov.