Adult Medicaid FFS Rates Increased 10%, Some Claims May Have Been Underpaid
The New Jersey Division of Medical Assistance and Health Services has confirmed a 10% increase in adult Medicaid Fee-for-Service (FFS) dental reimbursement rates effective January 1, 2025. This adjustment is designed to strengthen provider participation and patient access to care. Because of system delays, some claims may have been underpaid, and providers are urged to review and, if necessary, adjust affected claims to ensure they receive the full reimbursement now available.
Effective January 1, 2025, Fee-for-Service (FFS) dental procedure code rates were increased by 10% for claims paid at an adult rate. This includes both the Specialist and Non-Specialist rate schedules.
Children’s rates have not been increased.
However, many CDT codes do not have a separate children’s rate; when those codes are paid at the adult rate, the 10% increase applies.
Due to implementation delays and data processing errors, some claims were paid at the previous rates.
Action Needed
As of September 15, 2025, providers may adjust their claims to receive the correct reimbursement.
Who Should Review Their Claims
• All dental providers who bill under the Medicaid FFS program.
• Any provider whose claims were paid at an adult rate for dates of service on or after January 1, 2025.
• This applies whether you bill under the Specialist or Non-Specialist rate schedules.
Steps to Take
- Identify affected claims
- Review all FFS dental claims with dates of service January 1, 2025 or later.
- Focus on claims paid at an adult rate to confirm whether the 10% increase was applied.
- Submit adjustments
- File adjustments through the NJMMIS portal (or your billing platform) to capture the 10% increase where underpayment occurred.
- Be sure to indicate that the claim is being adjusted for the January 1, 2025 10% rate increase.
- Need help?
- Contact Gainwell Provider Services at 1-800-776-6334 for guidance on adjustment procedures and documentation requirements.
Timely review and adjustment will ensure that you receive the full reimbursement owed under the new rate schedules.
Thank you for your attention to this important update and for your continued care of New Jersey’s Medicaid patients.
