New Jersey Medicaid Fee Schedule 2026: CPT/HCPCS Rates & NJMMIS Lookup

The New Jersey Medicaid fee schedule for 2026 provides reimbursement rates for covered services paid through the state’s Fee-for-Service (FFS) system. The official rate information is published through NJMMIS, New Jersey’s Medicaid fiscal-agent website, under Rate and Code Information.

For 2026, the main FFS file is the Procedure Master Listing – Medicaid Fee for Service – CY 2026. New Jersey’s Medicaid State Plan identifies January 1, 2026 as the effective date for the applicable 2026 fee-schedule rates.

The New Jersey Medicaid fee schedule for 2026 is focused on provider reimbursement and rate information. If you are trying to find out whether you or a family member qualifies for coverage, see our New Jersey Medicaid eligibility guide.

CMS’s approval letter for New Jersey State Plan Amendment (SPA) NJ-26-0001 is dated June 17, 2026 and confirms the January 1, 2026 effective date.

New Jersey had an earlier CY 2026 rate reference with a January 1, 2026 effective date. That reference was later superseded by SPA NJ-26-0002, which identifies April 1, 2026 as the effective date for the updated CY 2026 Procedure Master Listing.

2026 NJ Medicaid Fee Schedule: Quick Answer

The rate that applies to a Medicaid claim can vary. It may depend on the CPT or HCPCS code, provider type, date of service, modifiers, units, program rules, and payment arrangement. A Fee-for-Service rate also does not automatically mean that every managed care organization will pay the same amount.

This guide explains how to find a New Jersey Medicaid CPT or HCPCS rate, use the NJMMIS fee schedule, understand the 2026 Procedure Master Listing, and tell the difference between Fee-for-Service and managed care reimbursement.

Because Medicaid payment rules can change by service and effective date, providers should verify the current NJMMIS information and any applicable program or managed-care requirements before using a rate for billing or payment decisions.

NJ Medicaid Fee Schedule 2026 — Official Lookup

The official New Jersey Medicaid fee schedule information is published through NJMMIS, New Jersey’s Medicaid Management Information System. Providers can access applicable rate schedules, procedure-code listings, and provider-specific payment information through the “Rate and Code Information” section of NJMMIS.com.

CMS’s approved New Jersey Medicaid State Plan documents direct providers and the public to NJMMIS for the applicable procedure-code listings and reimbursement rates. The state plan states that fee schedules and code listings are published at NJMMIS.com under “Rate and Code Information.”medicaid

For the current CY 2026 Medicaid Fee-for-Service schedule, CMS identifies the main file as:

Procedure Master Listing – Medicaid Fee for Service – CY 2026

As of August 25, 2026, the current CMS-approved state-plan reference is SPA NJ-26-0002. It supersedes SPA NJ-26-0001, identifies the CY 2026 Procedure Master Listing as last updated under SPA NJ-26-0002, and lists an effective date of April 1, 2026.medicaid

Where to Find the NJ Medicaid Fee Schedule

Start at NJMMIS.com and select “Rate and Code Information.” New Jersey does not provide one universal PDF that contains every Medicaid reimbursement rate for every provider type and service.

Instead, NJMMIS organizes payment information into separate fee-schedule files, rate tables, and provider-specific resources. The file or table needed depends on the service, program, procedure code, and provider type.

NJMMIS rate information can include:

• Medicaid Fee-for-Service procedure listings
• Home health agency rate tables
• Hospital inpatient and outpatient rate information
• Cost-to-charge ratio information
• Provider-specific rate tables
• Other provider-type or service-specific reimbursement files

This structure matters because a rate that applies to one provider type, program, or billing arrangement may not apply to another.

Example: New Jersey Home Health Medicaid Rates

NJMMIS publishes a CY 2026 statewide home health agency rate table with separate amounts for several services. The official table currently lists the following statewide rates:njmmis

NJMMIS also displays specific provider rates for certain home health agencies. Those agency-level figures can differ from the statewide figures, so a provider should verify the rate table and provider entry that applies to the individual service and billing entity.njmmis

Hospital reimbursement information is also published separately. For example, NJMMIS provides hospital-specific inpatient cost-to-charge ratio histories that may include an effective date, cost-to-charge ratio, base rate, final rate, and applicable add-on amounts.njmmis+1

How to Use the Official NJMMIS Lookup

When checking a New Jersey Medicaid reimbursement rate, use the following process:

1. Go to NJMMIS.com.
2. Open “Rate and Code Information.”
3. Select the fee-schedule file or rate category matching the service.
4. Identify the applicable CPT code, HCPCS Level II code, revenue code, provider type, or service category.
5. Confirm the date of service and the effective date shown for that rate file.
6. Review any provider-specific, service-specific, modifier, unit, authorization, or billing requirements that affect payment.
7. Confirm whether the claim is paid under traditional Medicaid Fee-for-Service or by a Medicaid managed care organization.

Under the current SPA NJ-26-0002 state-plan page, fees in the referenced schedules were generally set on April 1, 2026, unless a different effective date is specified. The state plan also states that the published fee schedule may not apply identically in every circumstance.medicaid

The safest approach is to use NJMMIS as the operational source for the current rate, then use the applicable CMS State Plan Amendment to confirm the rate file’s effective date and payment methodology.

CY 2026 Medicaid Fee-for-Service Procedure Master Listing

The Procedure Master Listing – Medicaid Fee for Service – CY 2026 is New Jersey’s main procedure-code file for Medicaid Fee-for-Service billing. CMS describes it as the main file of procedure codes billable to Medicaid for all services, except where the New Jersey Medicaid State Plan indicates a separate file or payment arrangement applies.medicaid

As of August 25, 2026, the current CMS-approved state-plan reference for the CY 2026 Procedure Master Listing is SPA NJ-26-0002. This amendment was approved on July 24, 2026, supersedes SPA NJ-26-0001, and has an effective date of April 1, 2026.medicaid

What the Procedure Master Listing Is Used For

The Procedure Master Listing is the primary New Jersey Medicaid Fee-for-Service reference for finding billable procedure codes and the applicable fee-schedule information.

Depending on the service, providers may need to verify:

• CPT codes
• HCPCS Level II codes
• Procedure descriptions
• Applicable reimbursement amount
• Billing units
• Modifiers
• Provider type
• Date of service
• Service-specific billing instructions
• Prior authorization or coverage requirements
• Program-specific payment rules

A rate shown in a procedure listing is not a guarantee that every claim will pay that exact amount. Final claim payment can be affected by Medicaid coverage rules, member eligibility, provider enrollment, authorization requirements, modifiers, billing units, claim edits, other insurance, program requirements, and whether the service is paid through Fee-for-Service or managed care.

Are All NJ Medicaid Services in the Main Listing?

No. The CY 2026 Procedure Master Listing is the main FFS procedure-code file, but it is not the only New Jersey Medicaid rate reference.

CMS state-plan documents identify separate files or payment methodologies for certain service categories and populations. Earlier New Jersey state-plan documents specifically identify separate listings for:

• Children’s Rates, excluding the Special Education Medicaid Initiative (SEMI)
• Outpatient Hospital Laboratory Billing Only

This means providers should not assume that every New Jersey Medicaid service uses the same procedure listing, reimbursement amount, or payment methodology.medicaid

The correct workflow is:

1. Identify the service and provider category.
2. Determine whether the service is paid under Medicaid Fee-for-Service or managed care.
3. Find the correct NJMMIS rate file or provider-specific table.
4. Verify the CPT, HCPCS, revenue code, or other billing code.
5. Confirm the applicable effective date, provider type, modifiers, units, and billing rules.

How the CY 2026 Listing Relates to Earlier Schedules

New Jersey uses a recurring state-plan structure in which the current year’s Procedure Master Listing is updated through approved State Plan Amendments.

For example, SPA NJ-25-0016 identified a Procedure Master Listing – Medicaid Fee for Service – CY 2025 and generally made its referenced rates effective October 1, 2025. SPA NJ-26-0001 subsequently referenced the CY 2026 listing with a January 1, 2026 effective date. The more recent SPA NJ-26-0002 now supersedes NJ-26-0001 and updates the relevant CY 2026 reference to an April 1, 2026 effective date.medicaid+1

The practical takeaway is simple: do not use an older calendar-year schedule or an earlier SPA effective date without checking the current NJMMIS listing and the newest applicable CMS state-plan document.

Check NJMMIS Updates and Alerts

Providers should monitor the NJMMIS Newsletters & Alerts, Recent Newsletters, announcements, and provider updates for changes affecting coding, billing, reimbursement, claims processing, or program rules. NJMMIS links these resources through its public website and document-download pages.njmmis+2

Avoid assigning a newsletter volume number unless you have verified the specific current newsletter directly from NJMMIS at the time of publication.

Important 2026 Verification Note

The CY 2026 Procedure Master Listing is the main New Jersey Medicaid Fee-for-Service procedure-code reference. It is not evidence that every Medicaid service follows one statewide rate, one billing rule, or one payment methodology.

Before relying on a rate for billing, verify:

• The correct CPT, HCPCS, revenue, or service code
• The applicable NJMMIS fee schedule or rate table
• The provider type and provider-specific rate, when applicable
• The effective date for the service date
• Modifiers and billing units
• Coverage and prior-authorization requirements
• Whether the claim is Fee-for-Service or managed care
• Any separate payment methodology or program-specific rule

This distinction is especially important for providers that bill across home health, hospital, behavioral health, children’s services, laboratory, durable medical equipment, or other specialized Medicaid categories.

How to Look Up a NJ Medicaid CPT or HCPCS Code

To find a New Jersey Medicaid reimbursement rate, start with NJMMIS.com, the state’s Medicaid Management Information System. CMS directs providers to the NJMMIS “Rate and Code Information” section for applicable procedure-code listings and Medicaid rates.

The code alone is not enough to determine the correct payment amount. The applicable rate can also depend on the provider type, program, date of service, units, modifiers, and whether the claim is paid through Fee-for-Service (FFS) or a Medicaid managed care organization (MCO).

Steps to Search the NJ Medicaid Fee Schedule

1. Go to NJMMIS.com.
2. Select “Rate and Code Information.”
   This is the NJMMIS area used for rate tables, procedure-code listings, and other provider reimbursement information.

1. Choose the rate category that matches the service.
   Depending on the service, you may need the Medicaid FFS Procedure Master Listing, a home health rate table, hospital rate information, or another provider- or service-specific file.
2. Search for the correct billing identifier.
   This may be a CPT code, HCPCS Level II code, revenue code, provider type, service description, or procedure listing.
3. Match the rate to the correct provider and service.
   NJMMIS can publish both statewide and provider-specific rates. A statewide amount may not apply to every provider.
4. Check the effective date.
   Make sure the rate applies to the actual date of service. The current 2026 state-plan materials can contain more than one effective date, so do not assume that every 2026 rate began on January 1.
5. Review billing requirements before submitting a claim.
   Check units, modifiers, prior authorization, coverage rules, provider enrollment, and any program-specific instructions. A published fee does not guarantee that every claim will pay that exact amount.
6. Use secure provider tools only when you need member-specific information.
   A Medicaid ID is used for member eligibility and claim-related functions in the secure provider environment. It is not needed to find a public fee-schedule rate.

Screenshot recommendation: Add an original screenshot showing the public NJMMIS navigation from “Rate and Code Information” to the relevant rate category. The screenshot should not contain Medicaid IDs, claim information, login details, or other protected health information.

Before You Rely on a Rate

Use NJMMIS as the operational source for the current rate. Then confirm the applicable effective date and broader payment methodology against the latest CMS-approved New Jersey State Plan documentation.

NJ Medicaid Reimbursement Rates by Provider Type

New Jersey Medicaid reimbursement rates are not contained in one universal chart. NJMMIS publishes rate information by provider type, service, and payment methodology.

The CY 2026 Procedure Master Listing is the main FFS procedure-code file, but some services use separate rate tables, provider-specific amounts, or managed-care payment arrangements.

Physician Rates

Physician and practitioner rates should be checked against the applicable CY 2026 NJ Medicaid fee schedule and NJMMIS rate information. The amount can vary by CPT or HCPCS code, provider classification, modifiers, units, place of service, and date of service.

Some 2026 legislation, including S3802 and A4265, proposes a payment floor for certain primary-care and mental-health services based on 100% of the applicable Medicare Part B rate beginning July 1, 2026. Do not present that as a current Medicaid rate unless the legislation has been enacted and NJMMIS or DMAHS has implemented the change.

The HealthySteps arrangement is different. It is a managed-care state-directed payment arrangement for qualifying primary-care practices and should not be described as a universal FFS CPT rate.

Home Health & Therapy Rates

NJMMIS publishes a statewide 2026 home health agency rate table along with certain provider-specific rates. Current statewide examples include:

These figures apply specifically to the home health agency rate table. They should not be treated as universal rates for every therapy, nursing, or home-care claim. NJMMIS can also show provider-specific amounts.

Behavioral Health Rates

NJ Medicaid behavioral health reimbursement can vary by service, procedure code, provider type, setting, and payment method. Some services may use FFS rates, while others may be paid through managed care or specialized program arrangements.

Do not use the proposed S3802/A4265 Medicare Part B parity language as proof of a current behavioral-health rate. Verify the applicable NJMMIS rate and payment arrangement for the specific service.

Dental Rates

NJ Medicaid dental reimbursement is based on the applicable dental procedure code, provider category, service date, and current NJMMIS rate information. Providers should verify the specific code rather than rely on a general statewide estimate.

The Healthy Smiles Act and A2229 should be described as proposed legislation unless an official New Jersey source confirms enactment and implementation. Do not present a proposed increase as an active Medicaid dental rate.

DME Rates

Durable medical equipment (DME) uses its own billing category and should be checked through NJMMIS using the applicable HCPCS Level II code, provider category, and date of service.

A DME payment can also depend on:

• rental or purchase status
• prior authorization
• medical-necessity and coverage rules
• supplier enrollment
• modifiers
• units and frequency limits
• repair, replacement, or accessory rules

Hospital & Outpatient Rates

Hospital reimbursement is more complex than a standard procedure-code fee schedule. NJMMIS publishes separate hospital information, including inpatient cost-to-charge ratios, base rates, final rates, and hospital-level data.

New Jersey also uses Medicaid managed-care state-directed payments for certain hospital services. These payments can include outpatient add-ons that are separate from the underlying FFS or base hospital payment.

For one CMS-approved outpatient hospital arrangement covering July 1, 2025 through June 30, 2026, the documented average interim add-on was $956.80 per outpatient visit for public facilities and $212.55 for private facilities. These are average managed-care add-on amounts, not the full Medicaid reimbursement rate for every outpatient service.

Hospital payment arrangements can also vary by program or county, so providers should check the applicable CMS/NJMMIS documentation rather than apply one statewide add-on to every hospital claim.

NJ Medicaid FFS vs. Managed Care Rates

New Jersey Medicaid uses both Fee-for-Service (FFS) and managed care payment arrangements. The payment method depends on the member’s enrollment, the service, the provider, and the rules that apply to the specific Medicaid or NJ FamilyCare program.

With Fee-for-Service, New Jersey pays an enrolled provider under the applicable NJMMIS fee schedule, rate table, or approved payment method. The CY 2026 Procedure Master Listing is the main procedure-code reference for many FFS services, although some services use separate rate files or payment methods.

With managed care, the member is enrolled in a Medicaid managed care organization (MCO). The MCO generally pays providers under its network contract. The payment may use a negotiated fee schedule, per-visit or per-diem rate, bundled payment, value-based arrangement, or another contract method.

What Is Medicaid Capitation?

At the state-to-MCO level, managed care generally uses capitation. This means New Jersey pays an MCO a prospective amount for each enrolled member for a defined period.

That capitation payment is not the provider’s payment for an individual service. The provider’s actual reimbursement is determined by the MCO-provider contract and any state or federal payment requirements.

When Can an FFS Rate Become a Managed-Care Minimum?

Some services have an FFS-based minimum payment floor that applies to managed care.

One 2026 example is Community-Based Palliative Care (CBPC). DMAHS identifies these minimum FFS-based reimbursement floors:

MCOs and providers may use alternative payment methods or incentives, but the applicable CBPC payment cannot fall below the required FFS floor. The $686 PMPM amount is specific to the CBPC bundle and should not be treated as a general monthly Medicaid rate for other services.

Why Can FFS and MCO Rates Differ?

A provider should not assume that an NJMMIS FFS rate is the exact amount an MCO will pay. The amount can depend on:

• FFS or MCO enrollment
• the provider’s MCO contract
• any applicable payment floor
• CPT or HCPCS code
• modifiers and units
• date of service
• prior authorization or medical-necessity rules
• bundled, per-diem, or value-based payment arrangements
• CMS-approved state-directed payments

For billing, use NJMMIS for FFS rates and the applicable MCO contract, provider manual, or plan guidance for managed-care claims.

2026 NJ Medicaid Rate Changes

New Jersey Medicaid payment information in 2026 includes FFS fee schedules, CMS-approved managed-care payment arrangements, and proposed legislation. These are different things and should not be presented as though they are all current reimbursement rates.

Confirmed 2026 Payment References

Proposed 2026 Legislative Changes

Some 2026 bills address Medicaid reimbursement, but a bill is not the same as an active Medicaid rate.

S3802 and A4265 propose a Medicaid reimbursement floor of at least 100% of the applicable Medicare Part B rate for specified primary-care and mental-health services beginning July 1, 2026. Do not describe that as a current statewide rate unless the bill is enacted and an official NJMMIS or DMAHS implementation notice confirms the change.

A good rule for this page is:

A bill, a CMS approval, an FFS fee schedule, and an MCO provider payment are not interchangeable. Always label which one you are describing.

Hospital State-Directed Payments

New Jersey also uses Medicaid managed-care state-directed payments (SDPs) for certain hospital services.

For one statewide acute-care outpatient arrangement covering July 1, 2025 through June 30, 2026, CMS documentation lists average interim add-ons of $956.80 per outpatient visit for public facilities and $212.55 for private facilities. These are managed-care add-on payments, not the full reimbursement rate for every outpatient hospital service. Final amounts are subject to reconciliation.

How Often NJ Medicaid Rates Change

There is no single date when all New Jersey Medicaid reimbursement rates change. Different services can have different effective dates based on the provider type, service category, State Plan Amendment, legislation, annual rate-setting process, MCO rating period, or other payment methodology.

For that reason, providers should always compare the date of service with the effective date shown on the applicable NJMMIS rate table or fee-schedule file.

Common NJ Medicaid Rate-Update Triggers

Rates can change when:

• DMAHS updates a fee schedule or Procedure Master Listing
• CMS approves a State Plan Amendment
• an approved payment methodology produces a new rate
• an enacted law changes reimbursement policy
• an MCO rating period changes
• CMS approves or renews a state-directed payment
• a provider-specific, hospital, or facility rate is revised
• NJMMIS publishes an operational or billing update

The current CY 2026 Procedure Master Listing is tied to SPA NJ-26-0002, which supersedes NJ-26-0001 and identifies an April 1, 2026 effective date for the updated listing. That does not mean every New Jersey Medicaid rate changed on April 1. Separate programs can have different effective dates.

Calendar Year, Fiscal Year, and Rating Periods

New Jersey Medicaid uses several different timing frameworks:

• CY 2026: Calendar-year rate files.
• State fiscal year: Often July 1 through June 30.
• MCO rating period: May use dates such as July 1, 2025 through June 30, 2026.
• Service-specific effective dates: May be set by an SPA, rate notice, or NJMMIS table.

For example, CBPC uses its own April 1, 2026 program timing, while the hospital outpatient state-directed payment uses a July 1, 2025 through June 30, 2026 rating period.

Federal Medicaid Payment-Rate Transparency

Federal Medicaid payment-transparency rules require states to publish FFS payment rates in a publicly accessible format. CMS guidance set July 1, 2026 as the deadline for the initial public FFS payment-rate publication, with later updates required after qualifying rate changes.

This does not mean every Medicaid rate changed on July 1, 2026. It is a transparency requirement. Individual NJ Medicaid rates can continue to follow their own effective dates.

Best Practice When Checking a Rate

Before using a New Jersey Medicaid rate for billing, record:

1. The CPT, HCPCS, or other billing code.
2. The provider type and rate category.
3. Whether the claim is FFS or managed care.
4. The date of service.
5. The NJMMIS table or file used.
6. The rate’s effective date.
7. Any applicable modifiers, units, authorization rules, or plan instructions.

This is more reliable than relying only on an article’s publication date, an old fee schedule, or a pending legislative proposal.

Frequently Asked Questions About the NJ Medicaid Fee Schedule

Official Sources and Verification

This guide was last reviewed on August 25, 2026. New Jersey Medicaid reimbursement can vary by service, procedure code, provider category, payment method, date of service, modifier, billing units, and whether a member receives care through Medicaid Fee-for-Service or a managed care organization.

For a billing, claim, enrollment, prior-authorization, or payment decision, use the official source that applies to the specific service and date of service. This article is an educational guide and is not an official payment determination.

Primary NJ Medicaid Fee Schedule Source

New Jersey Medicaid Management Information System (NJMMIS)
Use for: Current Medicaid Fee-for-Service procedure listings, rate and code information, provider-specific rate data, home health agency rates, hospital payment information, newsletters, alerts, provider updates, and related billing resources.

• Official website: NJMMIS.com
• Fee schedule and code information: NJMMIS Rate and Code Information
• Provider announcements: NJMMIS Announcements
• Recent newsletters: NJMMIS Recent Newsletters
• 2026 home health agency rate table: NJMMIS Home Health Agency Rates

CMS-approved New Jersey Medicaid State Plan documents direct users to NJMMIS’s “Rate and Code Information” section for applicable procedure-code listings and payment rates. NJMMIS should be treated as the operational source for current rate lookups.[medicaid][njmmis]

CMS State Plan Amendment Sources

Centers for Medicare & Medicaid Services (CMS)
Use for: Confirming the approved state-plan authority, fee-schedule methodology, effective date, scope, and whether a newer amendment supersedes an older one.

• Current CY 2026 reference: NJ SPA 26-0002
  SPA NJ-26-0002 was approved July 24, 2026, supersedes NJ-26-0001, and identifies the CY 2026 Procedure Master Listing reference with an effective date of April 1, 2026.[medicaid]
• Earlier 2026 reference: NJ SPA 26-0001
  This earlier amendment identified the CY 2026 Procedure Master Listing with a January 1, 2026 effective date, but it has been superseded by NJ-26-0002.[medicaid][medicaid]
• Earlier 2025 reference: NJ SPA 25-0016
  This document identifies the prior CY 2025 Procedure Master Listing and explains that separate files can apply to children’s services and outpatient hospital laboratory billing.[njmmis]

When a fee-schedule date differs between sources, use the newest applicable CMS-approved amendment and the current NJMMIS operational rate file for the specific service.

New Jersey DMAHS Sources

New Jersey Division of Medical Assistance and Health Services (DMAHS)
Use for: Program-specific policy, Medicaid benefit guidance, public notices, rate-change proposals, managed-care requirements, and service-specific billing or reimbursement instructions.

• DMAHS website: New Jersey DMAHS
• Community-Based Palliative Care overview: NJ FamilyCare CBPC Program
• CBPC MCO and provider guidance: Community-Based Palliative Care Guidance Packet
• CBPC frequently asked questions: Community-Based Palliative Care FAQ

DMAHS launched the NJ FamilyCare Community-Based Palliative Care benefit on April 1, 2026. Its guidance states FFS payment floors of $100 for an initial assessment, $85 for a reassessment, and $686 for the per-member-per-month service bundle; MCOs must reimburse at or above these floors for the applicable CBPC codes.[nj][nj][nj]

Official Rate-Change Notices

For service categories that are being updated, expanded, or submitted for federal approval, check the New Jersey Department of Human Services public-notice library.

• January 2026 FFS rate public notice: New Jersey Medicaid Fee-for-Service Rate Notice
• Assisted living rate-change notice: Assisted Living Facility Rate Change Notice

The January 2026 public notice states that DMAHS intended to update Medicaid Fee-for-Service rates for State Plan services using Medicare’s annual update, effective January 1, 2026, and that the resulting fee schedules would be published through NJMMIS Rate and Code Information when available. A later SPA or service-specific rate notice may supersede that timing for a particular service or file.[nj]

Managed-Care and Hospital Payment Sources

CMS Medicaid Managed Care State-Directed Payment documents
Use for: Understanding hospital add-ons, MCO-directed payments, quality or access payments, and other managed-care arrangements that are not standard FFS procedure-code rates.

• State-directed payment guidance: CMS State Directed Payments
• Statewide outpatient hospital arrangement: NJ Outpatient Hospital State-Directed Payment Approval
• CMS approval record for the outpatient arrangement: NJ Fee OPH Renewal
• HealthySteps primary-care arrangement: NJ HealthySteps Primary Care Payment Approval

These documents should be used carefully. A CMS-approved state-directed payment may create an MCO payment requirement or hospital add-on, but it is not automatically the standard Fee-for-Service rate for all providers or all claims.[medicaid][medicaid][medicaid][medicaid]

New Jersey Legislature Sources

New Jersey Legislature
Use for: Checking whether a proposed reimbursement bill is introduced, amended, passed, vetoed, signed into law, or otherwise enacted.

• Bill S3802: Primary Care and Mental Health Medicaid Reimbursement Proposal
• Bill A4265: Assembly Primary Care and Mental Health Reimbursement Proposal
• New Jersey Legislature bill search: NJ Legislature Bill Search

S3802 and A4265 propose that Medicaid reimbursement for qualifying primary-care and mental-health services be at least 100% of the applicable Medicare Part B amount. This is proposed statutory language, not evidence that the payment level is currently operational. Confirm enactment and a DMAHS/NJMMIS implementation notice before describing any bill as an active NJ Medicaid rate.[pub.njleg.state.nj][njleg.state.nj]

Federal Payment Transparency Source

CMS Medicaid Fee-for-Service Payment Rate Transparency Guidance
Use for: Understanding federal publication requirements for Medicaid FFS fee schedules and the timing of public rate updates.

• CMS guidance: Guide for States to the Fee-for-Service Provisions of the Final Rule

CMS guidance required the initial public publication of Medicaid FFS payment rates by July 1, 2026. This is a payment-transparency requirement; it does not mean all New Jersey Medicaid fee schedules started, changed, or reset on July 1, 2026.[medicaid]

How This Guide Uses Sources

This article follows the source hierarchy below:

1. Current NJMMIS rate table or procedure listing for the operational rate and service-level details.
2. Newest applicable CMS State Plan Amendment for approved effective dates and methodology.
3. DMAHS guidance or public notices for program-specific policy and payment instructions.
4. CMS managed-care/state-directed-payment approvals for MCO or hospital payment arrangements.
5. New Jersey Legislature records for the status of proposals, never as a substitute for an implemented rate.

If sources conflict, use the newest source that governs the provider type, service category, date of service, and payment arrangement.