Section He-W 531.01 - Definitions(a) "Cosmetic purpose" means a procedure done for the sole purpose of changing a physical appearance.(b) "Current procedural terminology (CPT) code" means a unique identifying code in the field of medical nomenclature and designated by the United States Department of Health and Human Services as the national coding standard utilized in government and private health insurance programs for reporting medical services and procedures.(c) "Department" means the New Hampshire department of health and human services.(d) "Healthcare Common Procedure Coding System (HCPCS)" means a standardized coding system used by Medicare that describes services and procedures. HCPCS includes CPT codes that are used primarily to identify products, supplies, and services not included in the normal CPT code list, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), when used outside a physician's office.(e) "Medicaid" means the Title XIX and Title XXI programs administered by the department which makes medical assistance available to eligible individuals.(f) "National Correct Coding Initiative (NCCI) edits" means standardized coding edits developed by the Centers for Medicare and Medicaid Services (CMS) to reduce improper coding and prevent inappropriate payments when incorrect code combinations are reported. (g) "Prior authorization agent" means an individual or organization contracted by the department, responsible for reviewing all prior authorization requests.(h) "Quality improvement organization (QIO)" means an organization or agency established in accordance with 42 CFR 475 that performs utilization and quality control peer reviews in accordance with 42 CFR 476 when contracted by the department for the performance of such reviews.(i) "Recipient" means any individual who is eligible for and receiving medical assistance under the medicaid program.(j) "Title XIX" means the joint federal-state program described in Title XIX of the Social Security Act and administered in New Hampshire by the department under the medicaid program.(k) "Title XXI" means the joint federal-state program described in Title XXI of the Social Security Act and administered in New Hampshire by the department under the medicaid program.N.H. Admin. Code § He-W 531.01
Amended by Volume XXXIV Number 16, Filed April 17, 2014, Proposed by #10531, Effective 3/29/2014, Expires3/29/2024.Amended by Volume XXXIX Number 28, Filed July 11, 2019, Proposed by #12818, Effective 7/1/2019, Expires 7/1/2029.Amended by Volume XL Number 11, Filed March 12, 2020, Proposed by #12999, Effective 3/5/2020, Expires 3/5/2030.