N.J. Admin. Code § 10:58-3.1

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

Section 10:58-3.1 - Introduction

(a) The New Jersey Medicaid/NJ FamilyCare programs adopted the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d et seq., and incorporated herein by reference, as amended and supplemented, and published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions, and replacement codes) will be reflected in this chapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. The HCPCS Level I codes consist of the American Medical Association (AMA) Current Procedural Terminology (CPT) codes, which are assigned to specific procedures by the AMA. HCPCS Level II codes are assigned to specific procedures by CMS. An updated copy of the CPT codes may be obtained from the American Medical Association, P.O. Box 10950, Chicago, IL 60610, or by accessing www.ama-assn.org. An updated copy of the Level II codes may be obtained by accessing the HCPCS website at www.cms.hhs.gov/medicare/hcpcs or by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010.

(b) Listed below are some of the general policies of the New Jersey Medicaid/NJ FamilyCare programs relevant to HCPCS. (The responsibility of the CNM when rendering specific services and requesting reimbursement is listed in N.J.A.C. 10:58-1.)

1. When filing a claim, the HCPCS procedure codes, including modifiers, must be used in accordance with the narratives in the CPT or N.J.A.C. 10:58-3.3, 3.4 and 3.5, whichever is applicable.

2. The use of a procedure code will be interpreted by the New Jersey Medicaid/NJ FamilyCare programs as evidence that the CNM personally furnished, as a minimum, the stated service.

N.J. Admin. Code § 10:58-3.1

Amended by R.2001 d.204, effective 6/18/2001.
See: 33 N.J.R. 1160(a), 33 N.J.R. 2188(a).
Substituted references to CPT for references to CPT-4 and inserted references to NJ FamilyCare throughout; in (b), deleted "of this chapter" following "N.J.A.C. 10:58-1" in the introductory paragraph.
Amended by R.2006 d.338, effective 9/18/2006.
See: 38 N.J.R. 2003(a), 38 N.J.R. 3900(a).
Rewrote (a).

Amended by 53 N.J.R. 1843(c), effective 11/1/2021