New Jersey Integrated Care for Kids (NJ InCK)
On January 1, 2022, we began to support the efforts of NJ InCK, a multi-sector collaborative child-centered local service delivery model aimed at reducing out-of-home placement as well as health care costs for children covered by NJ FamilyCare.
This program helps provide care coordination for at-risk members through the age of 20 who are residents of Ocean and Monmouth Counties. The program supports prevention, early identification and treatment of priority health concerns like behavioral health challenges, physical health needs and social challenges.
You May Be Eligible for Additional Payments
Pediatric providers who implement the NJ InCK Needs Assessment for enhanced Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screening and care planning for Ocean and Monmouth County members enrolled in NJ FamilyCare may be eligible for additional payments.
We will consider claims for reimbursement when submitted by pediatric providers (located in any NJ county) who have implemented the NJ InCK Needs Assessment for enhanced EPSDT screening and care planning for the following services provided to their pediatric patients who reside in Ocean or Monmouth Counties.
- G9919 base code appended with 33 modifier: Interpretation of NJ InCK Needs Assessment Tool for a beneficiary assigned to Service Integrations Levels (SIL) 2 or 3
- G9920 base code appended with 33 modifier: Interpretation of NJ InCK Needs Assessment Tool for a beneficiary assigned to SIL 1
Important information about billing and reimbursements:
- The codes cannot be billed alone, but can be combined with another office visit code (e.g., pediatric annual visit).
- Generally, one service will be considered for reimbursement per calendar year.
- One additional reimbursement (up to two services per year) will be considered for beneficiaries younger than 36 months old and for beneficiaries assigned to SIL 3.
- Additional reimbursements may be considered during the year if a reassessment is determined as medically necessary to monitor changes in the beneficiary’s progress (per standard EPSDT coverage).
We encourage you to review the NJ InCK website for more information.
If you have questions, please contact your Network Specialist.