N.J. Admin. Code § 10:50-2.1

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

Section 10:50-2.1 - Introduction

(a) The New Jersey Medicaid/NJ FamilyCare program adopted the Federal Centers for Medicare & Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with 42 CFR 424, 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 (code additions and deletions, and replacement codes) will be reflected in this subchapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Division and specification of new reimbursement amounts for new codes will be made in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. The HCPCS codes as listed in this subchapter are relevant to Medicaid/NJ FamilyCare fee-for-services transportation services and must be used when filing a claim. An updated copy of the HCPCS codes may be obtained by accessing www.njmmis.com.

1. The responsibility of the transportation services provider when rendering services and requesting reimbursement is listed in Subchapter 1 and Subchapter 2 of this manual.

2. The column titled Maximum Fee Allowance indicates the amount of reimbursement or the symbol B.R.:

i. "B.R." (By Report) is listed instead of a dollar amount. It means that additional information will be required in order to properly evaluate the service. Attach a copy of the report to the MC-12 claim form.

(b) The following modifiers shall accompany the appropriate HCPCS procedure codes when applicable:

1.	"22"	Mileage, ground ambulance and mobility assistance vehicle service, in excess of 15 miles one way (see 10:50-1.6(d)).
2.	"GY"	Non-Medicare-covered service--to indicate that a ground ambulance service provided to a Medicare/Medicaid or Medicaid/NJ FamilyCare beneficiary is NOT reimbursable by Medicare because the place of destination is a physician's office, a clinic, or a dialysis facility, etc. Use modifier "GY" following all applicable HCPCS procedure codes when billing Medicaid/NJ FamilyCare for the non-Medicare reimbursable service; an Explanation of Medicare Benefits statement is not required.
3.	"76"	Repeat procedure--same day--to indicate that the service duplicates a service previously rendered to the same beneficiary on the same day. Use modifier "76" following all HCPCS procedure codes when billing for the repeat service. Do NOT use the modifier to bill for the first service. Failure to use modifier "76" to indicate a second service on the same date of service will result in the denial of the second service as a duplicate. Likewise, affixing modifier "76" to both services will cause the claims to deny as duplicates.

N.J. Admin. Code § 10:50-2.1

Recodified from N.J.A.C. 10:50-3.1 by R.1992 d.83, effective 2/18/1992.
See: 23 New Jersey Register 3619(a), 24 New Jersey Register 610(a).
Amended by R.1992 d.447, effective 11/16/1992.
See: 24 New Jersey Register 2517(a), 24 New Jersey Register 4264(a).
Added new subsection (b).
Amended by R.1999 d.5, effective 1/4/1999.
See: 30 New Jersey Register 3625(a), 31 New Jersey Register 58(a).
In (a), inserted a reference to NJ KidCare programs, and inserted a reference to NJ KidCare fee-for-service; and in (b), substituted "mobility assistance vehicle" for "invalid coach" in 1 and 2, substituted references to beneficiaries for references to recipients in 2 through 4, and inserted a reference to Medicaid/NJ KidCare and inserted a reference to NJ KidCare in 3.
Administrative change.
See: 32 New Jersey Register 708(a).
Amended by R.2006 d.213, effective 6/19/2006.
See: 37 N.J.R. 4850(a), 38 N.J.R. 2713(a).
Substituted "FamilyCare" for "KidCare" throughout; rewrote the introductory paragraph of (a); and deleted former (b)2, recodified (b)3 and (b)4 as present (b)2 and (b)3, and in (b)2, added "GY" at the beginning, and substituted "GY" for "XE" in the second sentence.

Amended by 54 N.J.R. 620(b), effective 4/4/2022