New Jersey Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in New Jersey, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This New Jersey billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
New Jersey billing guide: how New Jersey pays for outpatient care
NJ FamilyCare, New Jersey's Medicaid program, is run by the Division of Medical Assistance and Health Services (DMAHS). Five managed care organizations serve members, and since January 1, 2025 many outpatient mental health and substance use services are paid by those plans instead of fee-for-service. Enroll through NJMMIS first, then credential with each plan.
New Jersey is moving behavioral health into managed care in phases, so check whether a service has moved before you pick the payer. Starting January 1, 2027, adults 19 to 64 in NJ FamilyCare Plan ABP face a work requirement.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid (NJ FamilyCare) | DMAHS; five managed care plans; NJMMIS for enrollment | DMAHS provider resources |
| Medicare Part B | Novitas Solutions, Jurisdiction L | CMS MAC page |
| Blue Cross Blue Shield | Horizon Blue Cross Blue Shield of New Jersey | See the Blue Cross section below |
New Jersey Medicaid: NJ FamilyCare
This New Jersey billing guide starts with Medicaid, because it decides who pays and how you file.
Phase 1 of behavioral health integration went live January 1, 2025. It moved outpatient mental health, outpatient and intensive outpatient substance use treatment, partial care, PACT and certified community behavioral health clinics into the plans. Phase 2, residential and opioid treatment programs, stays fee-for-service for now. The Division of Mental Health and Addiction Services (DMHAS) March 2026 slides say Phase 2 will not go live in 2026 and is planned for 2027, and mark that timing as pre-decisional.
DMAHS says plans must accept any willing and qualified provider. Out-of-network providers without a continuity-of-care agreement are paid at the fee-for-service rate floor.
| Item | What to know |
|---|---|
| Agency | Division of Medical Assistance and Health Services |
| Provider enrollment | NJMMIS provider enrollment. Enroll first, then credential with each plan. All five plans accept CAQH. Source |
| Who can enroll | Full licensure (LCSW, LPC, LMFT, LCADC) is required for individual enrollment. Supervised licenses cannot enroll as individual practitioners. Source |
| Fee-for-service filing window | Non-institutional claims must reach the fiscal agent within one year of the date of service under N.J.A.C. 10:49-7.2. Check each plan's limit for managed care claims. Source |
| Transition ending | DMAHS began ending the behavioral health transition period plan by plan on 11/1/2025, starting with Aetna Better Health. Then medical necessity applies to prior authorizations. Source |
| Work requirement | Starting January 1, 2027, adults 19 to 64 in NJ FamilyCare Plan ABP must show 80 hours a month of work, school, training or volunteering, or income of at least $580 a month. Current members are checked at their first renewal in March 2027, and ABP members renew every 6 months. Medically frail people, including those with a disabling mental health disorder, are excluded. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Aetna Better Health of New Jersey | Listed on the DMAHS health plans page. |
| Fidelis Care | Listed on the DMAHS health plans page. |
| Horizon NJ Health | Listed on the DMAHS health plans page. |
| UnitedHealthcare Community Plan | Listed on the DMAHS health plans page. |
| Wellpoint | Listed on the DMAHS health plans page as formerly Amerigroup New Jersey. |
Prior authorization: DMHAS says substance use prior authorizations go through NJSAMS and mental health prior authorizations go through each plan's portal. Source
Medicare Part B in New Jersey
For Medicare, this New Jersey billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Novitas Solutions, Inc. |
| Jurisdiction | Jurisdiction L: Delaware, the District of Columbia, Maryland, New Jersey and Pennsylvania |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in New Jersey
This part of the New Jersey billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. The main Blue plan in New Jersey is Horizon Blue Cross Blue Shield of New Jersey. Anthem is not the New Jersey Blue licensee. Check the member's card, and do not apply another state's Blue rules to Horizon.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Horizon Blue Cross Blue Shield of New Jersey | Horizon | New Jersey | Horizon behavioral health provider page |
Other private payers and EAPs in New Jersey
The New Jersey billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in New Jersey. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Horizon Blue Cross Blue Shield of New Jersey | Horizon has a Horizon Behavioral Health program for providers. Check its page for how preauthorization works before you bill. | Official page |
| NJ FamilyCare plans | Bill other insurance first and Medicaid last. For members in a plan, bill the plan. | Official page |
New Jersey billing guide: state law that changes billing
Use this section of the New Jersey billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in New Jersey. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Department of Banking and Insurance Bulletin 24-14, dated October 31, 2024, says carriers must cover mental health and substance use conditions on the same terms as any other sickness, and must approve in-plan exceptions when the network lacks a qualified, accessible provider for a medically necessary service. Bulletin
Telehealth payment parity
P.L.2021, c.310 requires health benefits plans to pay covered telehealth at the same rate as in-person care, and audio-only behavioral health at the full in-person rate. P.L.2024, c.105 extended the parity period to July 1, 2026, and the Governor signed a further extension on June 30, 2026. Check the enacted text for the current end date. P.L.2024, c.105
Medicaid timely filing
N.J.A.C. 10:49-7.2 gives one year from the date of service for non-institutional claims, 30 days for EPSDT claims, and 90 days after Medicare adjudication for crossover claims when the year has passed. Rule
Not legal advice. Confirm statute details with counsel.
New Jersey billing guide: codes and rates
This New Jersey billing guide lists only codes and rates confirmed on official pages.
These are the New Jersey-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Mental health codes with no prior authorization in Phase 1 | 90791, 90792, 90832 to 90839, 90846, 90847, 90849, 90853 and 90887. Prior authorization applies to TMS 90867 to 90869, ECT 90870 and partial care H0035. Plans must pay at or above fee-for-service rates. Source |
| Substance use equivalents | Substance use codes carry the HF modifier, for example H0023 HF and H0038 HF. Source |
| Substance use lab codes | 80305, 80306, 80307, G0480 and G0481 move under managed care on July 1, 2026, billed at the fee-for-service floor. Source |
New Jersey billing guide: what changed, newest first
Check this New Jersey billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | NJ FamilyCare work requirement begins for adults 19 to 64 in Plan ABP. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | Substance use lab services move to managed care. | Source |
| 2026-06-30 | Governor signed S-3947/A-4357, extending certain telehealth pay parity. | Source |
| 2026-03-01 | DMHAS says Phase 2 behavioral health integration is planned for 2027. | Source |
| 2025-11-01 | Plans begin ending the behavioral health transition period, starting with Aetna Better Health. | Source |
| 2025-01-01 | Phase 1 behavioral health integration went live. | Source |
How do I bill mental health claims in New Jersey?
These answers come from the same sources as the rest of this New Jersey billing guide.
Start with the member's payer type. For NJ FamilyCare, bill the member's managed care plan for outpatient mental health, after enrolling in NJMMIS and credentialing with that plan. Medicare Part B goes to Novitas Solutions in Jurisdiction L. Horizon Blue Cross Blue Shield of New Jersey is the main Blue plan for commercial members.
Questions about billing in New Jersey
Who do I bill for NJ FamilyCare outpatient mental health claims?
Bill the member's managed care plan. Enroll through NJMMIS first, then credential with each plan.
Which therapists can enroll in NJ Medicaid?
DMAHS requires full licensure, such as LCSW, LPC, LMFT or LCADC, for individual enrollment. Supervised licenses cannot enroll as individual practitioners.
What is the NJ Medicaid fee-for-service timely filing limit?
One year from the date of service for non-institutional claims under N.J.A.C. 10:49-7.2. Check each plan for its own limit.
When does the NJ FamilyCare work requirement start?
January 1, 2027 for new applicants and at the first renewal in March 2027 for current members, for adults 19 to 64 in Plan ABP.
Does MCM South bill for practices in New Jersey?
MCM South currently serves ten states; request a quote to ask about New Jersey.
Sources for the New Jersey billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- DMAHS provider resources, checked October 25, 2026
- NJ FamilyCare health plans under contract, checked October 25, 2026
- DMAHS work requirements, checked October 25, 2026
- NJMMIS provider enrollment, checked October 25, 2026
- BH integration provider readiness packet, checked October 25, 2026
- BH integration enrollment and credentialing FAQ, checked October 25, 2026
- DMAHS Phase 1 transition guidance, checked October 25, 2026
- DMHAS Advisory Hub, March 2026, checked October 25, 2026
- N.J.A.C. 10:49-7.2, checked October 25, 2026
- DOBI Bulletin 24-14, checked October 25, 2026
- P.L.2024, c.105, checked October 25, 2026
- CMS: MAC Jurisdiction L, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for New Jersey
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- New York insurance companies contact guide
- Pennsylvania insurance companies contact guide
Billing in New Jersey? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about New Jersey.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.