CurrentUnitedHealthcarePolicy CS137NJ.W

Home Health, Skilled, and Custodial Care Services (for New Jersey Only)

UnitedHealthcare medical policy CS137NJ.W governs home health, skilled, and custodial care services for members in the state of New Jersey and refers to NJ Administrative Code Title 10, Chapter 60 for medically necessary clinical criteria. The policy lists applicable procedure and HCPCS/CPT codes for reference and notes state-specific fee schedule exclusions.

Policy Summary

PayerUnitedHealthcare

PolicyHome Health, Skilled, and Custodial Care Services (for New Jersey Only)

Policy CodePolicy CS137NJ.W

Change TypeCode removals & administrative updates

Effective DateJan 1, 2026

Next Review Date

Key ActionProviders must use the New Jersey Administrative Code Title 10, Chapter 60 (Home Care Services) to establish medical necessity when requesting home health services; the policy defers to that regulation for clinical criteria.

SourceLink

POLICY UPDATE CHANGES

Removed HCPCS codes S9339 and T1031 from Applicable Codes.

Removed reference link to the Medical Policy titled Home Hemodialysis (for New Jersey Only) (retired Apr. 1, 2026).

Archived previous policy version CS137NJ.V.

~300Reference procedure/HCPCS/CPT codes listed

1State applicability (New Jersey only)

1Linked regulatory source (N.J.A.C. 10:60)

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Coverage Summary

This UnitedHealthcare medical policy CS137NJ.W covers Home Health, Skilled, and Custodial Care Services and is CURRENT for services in New Jersey only. Effective Date: 2026-01-01; Last Review: 2026-04-01. For medical necessity determinations the policy defers to N.J.A.C. 10:60 (Home Care Services) as the authoritative clinical criteria for coverage in New Jersey.

Policy metadata

Policy numberCS137NJ.W

Effective dateJanuary 1, 2026

Last reviewApril 1, 2026

State applicabilityNew Jersey only

Linked regulatory sourceN.J.A.C. 10:60 (Home Care Services)

Number of reference codes listed~300

Medical Necessity Criteria

Coverage Rationale

For medical necessity clinical coverage criteria, the policy defers to the New Jersey Administrative Code Title 10, Chapter 60 (Home Care Services).

ALL of the following

Policy applies only to services in the state of New Jersey (This Medical Policy only applies to the state of New Jersey).
Medically necessary coverage criteria are those defined in N.J.A.C. 10:60 Home Care Services (refer to that regulation).
Listing of codes in the policy is for reference only and does not itself determine coverage; benefit coverage is governed by federal, state, or contractual requirements and applicable laws and the inclusion of a code does not imply reimbursement or payment guarantee.

Medical necessity determinations for services described in this policy must follow applicable federal, state, or contractual rules as noted in the policy's criteria tree and instructions for use. The policy references the defined term Medically necessary, which is defined as: Determined according to New Jersey Administrative Code Title 10, Chapter 60 Home Care Services.

Coding (reference lists)

Applicable CPT/HCPCS/T Codes (reference list)mixed

99500	Home visit for prenatal monitoring and assessment
99501	Home visit for postnatal assessment and follow-up care
99502	Home visit for newborn care and assessment
99503	Home visit for respiratory therapy care
99504	Home visit for mechanical ventilation care
99505	Home visit for stoma care and maintenance
99506	Home visit for intramuscular injections
99507	Home visit for care and maintenance of catheter(s)
99511	Home visit for fecal impaction management and enema administration
99512	Home visit for hemodialysis

1–10 of 141

1/15

Codes Not on NJ Medicaid Fee Schedule (asterisked in policy)mixed

99501	asterisk indicated (may not be on NJ Medicaid Fee Schedule)
99503	asterisk indicated
99505	asterisk indicated
99506	asterisk indicated
99507	asterisk indicated
99511	asterisk indicated
99512	asterisk indicated
99601	asterisk indicated
G0088	asterisk indicated
G0089	asterisk indicated

1–10 of 36

1/4

The procedure and HCPCS/CPT codes listed in this policy are provided for reference only and do not by themselves determine coverage or guarantee payment. Codes marked with an asterisk are not on the State of New Jersey Medicaid Fee Schedule and therefore may not be covered by NJ Medicaid. Per the policy changes effective 2026-01-01, HCPCS codes S9339 and T1031 were removed from the Applicable Codes list.

Provider Actions

Documentation Required

Reference state regulation for medical necessity

Providers must use the New Jersey Administrative Code Title 10, Chapter 60 (Home Care Services) to establish medical necessity when requesting home health services; the policy defers to that regulation for clinical criteria.

See N.J.A.C. 10:60 as the required source for establishing medical necessity.

Billing Rule

Code listing is reference-only

Listing of procedure and diagnosis codes in the policy is provided for reference only and does not guarantee reimbursement or coverage; coverage is determined by federal, state, or contractual requirements.

Code listing does not guarantee reimbursement — coverage is determined by federal, state, or contractual requirements and applicable laws.

Background

Background: This UnitedHealthcare medical policy provides interpretive guidance for home health, skilled, and custodial care services for members in the state of New Jersey and directs readers to the New Jersey Administrative Code, Title 10, Chapter 60 (Home Care Services) for the medically necessary clinical criteria. The policy includes an illustrative list of applicable procedure and HCPCS/CPT codes for reference; inclusion of a code does not imply coverage and some codes are not on the New Jersey Medicaid Fee Schedule.

Medically necessary: Determined according to New Jersey Administrative Code Title 10, Chapter 60 Home Care Services.

Revision History

04/01/2026removedLatest

Removed reference link to the Medical Policy titled Home Hemodialysis (for New Jersey Only) (retired Apr. 1, 2026). (is_material: false)

01/01/2026removed

Removed HCPCS codes S9339 and T1031 from Applicable Codes. (is_material: true)

01/01/2026revised