N.J. Admin. Code § 10:54-9.4

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:54-9.4 - HCPCS procedure codes and maximum fee schedule for medicine

Maximum Fee	Anes
HCPCS	Allowance	Basic
IND	Code	Mod	S	$	NS	Units
N	99183	27.00	NA
N	99190	45.00	NA
N	99191	33.75	NA
N	99192	22.50	NA
99195	28.00	28.00
99199	BR	BR
N	99201	16.00	14.00
N	99202	16.00	14.00
N	99203	22.00	17.00
N	99204	22.00	17.00
N	99205	22.00	17.00
E N	99211	16.00	14.00
99211	WM	NA	11.20
E N	99212	16.00	14.00
99212	WM	NA	11.20
E N	99213	16.00	14.00
99213	WM	NA	11.20
E N	99214	16.00	14.00
99214	WM	NA	11.20
E N	99215	16.00	14.00
E N	99215	WM	NA	11.20
N	99217	16.00	14.00
N	99221	22.00	17.00
N	99222	22.00	17.00
N	99223	22.00	17.00
N	99231	16.00	14.00
N	99232	16.00	14.00
N	99233	16.00	14.00
99238	16.00	14.00
N	99241	44.00	NA
N	99242	44.00	NA
N	99243	44.00	NA
N	99244	62.00	NA
N	99245	62.00	NA
N	99251	44.00	NA
N	99252	44.00	NA
N	99253	44.00	NA
N	99254	62.00	NA
N	99255	62.00	NA
N	99261	16.00	14.00
N	99262	16.00	14.00
N	99263	16.00	14.00
N	99271	44.00	NA
N	99272	44.00	NA
N	99273	44.00	NA
N	99274	62.00	NA
N	99274	YY	50.00	NA
N	99274	ZZ	50.00	NA
N	99275	62.00	NA
N	9928	19.00	7.00
N	99282	9.00	7.00
N	99283	9.00	7.00
N	99284	9.00	7.00
N	99285	9.00	7.00
N	99291	45.00	40.00
N	99292	22.50	20.00
99293	435.10	369.90
99294	198.50	169.10
99299	60.00	51.00
N	99301	22.00	17.00
N	99302	22.00	17.00
N	99303	22.00	17.00
E N	99311	16.00	14.00
E N	99312	16.00	14.00
E N	99313	16.00	14.00
N	99321	22.00	17.00
N	99322	22.00	17.00
N	99323	22.00	17.00
E N	99331	16.00	14.00
E N	99332	16.00	14.00E
N	99333	16.00	14.00
N	99341	16.00	14.00
N	99341	WM	NA	11.20
N	99342	16.00	14.00
N	99342	WM	NA	11.20
N	99343	35.00	35.00
N	99351	16.00	14.00
N	99351	WM	NA	11.20
N	99352	16.00	14.00
N	99352	WM	NA	11.20
N	99353	35.00	35.00
N	99354	45.00	40.00
N	99355	22.50	20.00
N	99356	45.00	40.00
N	99357	22.50	20.00
N	99382	22.00	17.00
N	99383	22.00	17.00
N	99384	22.00	17.00
N	99385	22.00	17.00
N	99386	22.00	17.00
N	99387	22.00	17.00
N	99391	16.00	14.00
N	99392	22.00	17.00
N	99393	22.00	17.00
N	99394	22.00	17.00
N	99395	22.00	17.00
N	99396	22.00	17.00
N	99397	22.00	17.00
N	99431	27.00	23.00
99499	BR	BR
99600	BR	BR
L	H5025	8.00	6.00
N	J0690	1.92	1.92
N	J0696	10.24	10.24
N	J1100	0.80	0.80
N	J1200	0.55	0.55
N	J2550	0.42	0.42
N	J2680	9.50	9.50
N	J2790	20.40	20.40
N	J2790	22	72.07	72.07
J3395	Average Wholesale Price (AWP)
N	J9000	42.00	42.00
N	J9010	195.50	195.50
N	J9020	50.36	50.36
N	J9031	152.13	152.13
N	J9040	255.08	255.08
N	J9045	72.01	72.01
N	J9060	30.33	30.33
N	J9070	4.91	4.91
N	J9100	6.72	6.72
N	J9130	12.00	12.00
N	J9190	0.18	0.18
N	J9217	451.25	451.25
N	J9230	10.10	10.10
N	J9240	9.05	9.05
N	J9240	22	31.50	31.50
N	J9260	4.75	4.75
N	J9280	119.08	119.08
N	J9360	3.25	3.25
N	J9370	27.50	27.50
L	W9025	72.00	69.00
L	W9025	WM	NA	67.00
L	W9026	22.00	21.00
L	W9026	WM	NA	19.00
L	W9027	465.00	418.00
L	W9027	WM	371.00
L	W9028	22.00	21.00
L	W9028	WM	19.00
L	W9029	487.00	439.00
L	W9029	WM	390.00
L	W9030	867.00	802.00
L	W9030	WM	723.00
L	W9031	595.00	531.00
L	W9040	30.00	30.00
L	W9041	120.00	120.00
L	W9042	50.00	50.00
L	W9043	100.00	100.00
L	W9050	27.00	27.00
L	W9055	27.00	27.00
L	W9060	31.00	26.00
L	W9060	WT	23.00	18.00
L	W9061	31.00	26.00
L	W9061	WT	23.00	18.00
L	W9062	31.00	26.00
L	W9062	WT	23.00	18.00
L	W9063	31.00	26.00
L	W9063	WT	23.00	18.00
L	W9064	31.00	26.00
L	W9064	WT	23.00	18.00
L	W9065	31.00	26.00
L	W9065	WT	23.00	18.00
L	W9066	31.00	26.00
L	W9066	WT	23.00	18.00
L	W9067	31.00	26.00
L	W9067	WT	23.00	18.00
L	W9068	31.00	26.00
L	W9068	WT	23.00	18.00
L	W9095	6.60	6.60
L	W9096	17.46	17.46
L	W9096	22	32.79	32.79
L	W9096	52	2.50	2.50
L	W9097	17.46	17.46
L	W9097	52	2.50	2.50
L	W9098	32.79	32.79
L	W9098	52	2.50	2.50
L	W9099	63.57	63.57
L	W9099	52	2.50	2.50
L	W9170	13.00	13.00
L	W9200	12.00	NA
L	W9205	70.00	NA
L	W9210	70.00	NA
L	W9215	9.00	NA
L	W9220	16.00	NA
L	W9310	51.00	NA
L	W9333	27.88	27.88
L	W9333	52	2.50	2.50
L	W9334	27.88	27.88
L	W9334	52	2.50	2.50
L	W9335	62.09	62.09
L	W9335	52	2.50	2.50
L	W9336	36.90	36.90
L	W9337	2.34	2.34
L	W9338	30.27	30.27
L	W9339	360.63	360.63
L	W9343	451.25	451.25
L	W9344	811.25	811.25
L	W9345	902.50	902.50
L	W9378	16.00	NA
L	W9382	16.00	NA
L	W9384	16.00	NA
L	W9385	16.00	NA
L	W9386	16.00	NA
L	W9387	16.00	NA
L	W9388	16.00	NA
L	W9450	100.00	NA
L	W9450	2633.00	NA
L	W9820	23.00	18.00
L	W9840	150.00	150.00
L	W9847	63.00	NA
L	W9848	28.00	30.00
L	W9849	28.00	30.00
L	Z0250	WM	NA	40.00
L	Z0300	7.00	7.00
L	Z0310	45.00	45.00

Amended by R.2004 d.51, effective February, 2, 2004.
See: 35 N.J.R. 3027(a), 36 N.J.R. 664(b).
Deleted HCPS Code 92599 and inserted codes 92601 through 92700, 93580 through 93581, 95990, 96920 through 96922, 99293 through 99299 and 99600.
Amended by R.2006 d.26, effective 2/6/2006.
See: 37 N.J.R. 3538(a), 38 N.J.R. 966(a).
Added the HCPCS procedure code J3395.