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Starting January 1, 2025, Fidelis Care will provide outpatient behavioral health benefits to NJ FamilyCare members. Learn more about the behavioral health benefit changes (PDF).

Prior Authorization Updates: Effective July 1, 2025

April 29, 2025

Effective July 1, 2025, the following codes will require prior authorization to be submitted to Fidelis Care.

  • J0897: Injection, denosumab, 1 mg
  • 64450: Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
  • Q0138: Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

The following codes will no longer require prior authorization:

  • 97606: Negative pressure wound therapy (eg, vacuum-assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
  • 97605: Negative pressure wound therapy (eg, vacuum-assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

If you have questions, please contact Provider Services.