N.J. Admin. Code § 10:52-10.3

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

Section 10:52-10.3 - HCPCS Code Numbers, Procedure Description and Maximum Fee Schedule; Pathology/Laboratory (Codes and Narratives Not Found in CPT)

PATHOLOGY/LABORATORY
HCPCS	Maximum Fee
IND	Code	MOD	Procedure Description	Allowance
G0027	Semen analysis; presence	2.40
and/or motility of sperm
excluding Huhner test
G0123	Screening cytopathology,	23.50
cervical or vaginal, thin
prep, auto
G0141	Screening cytopathology	10.00
smears, cervical or vaginal
performed by automated
system, with manual
rescreening requiring
interpretation by physician
G0306	Complete CBC, automated	5.00
(HGB, HCT, RBC, WBC, without
platelet count) and automated
WBC differential count
G0307	Complete CBC, automated	4.80
(HGB, HCT, RBC, WBC, without
platelet count)
G0328	Colorectal cancer	7.00
screening; fecal-occult blood
test, immunoassay, 1-3
simultaneous determinations
J0886	Injection, Epoetin Alpha,	13.31
1000 units (for ESRD patients
on dialysis)
P3000	Screening Papanicolaou	6.00
smear, cervical or vaginal,
up to three smears; by
technician under physician
supervision
P3001	Requiring interpretation	6.00
by physician
P9010	Blood transfusion, whole	S.C.C.
blood (per unit)
P9011	Blood transfusion, split	S.C.C.
unit, (specify amount)
P9012	Cryopreipitate, each unit	S.C.C.
P9016	Leukocyte poor blood, each	S.C.C.
unit
P9017	Fresh frozen plasma,	S.C.C.
single
P9019	Platelets, each unit	S.C.C.
P9020	Platelet rich plasma, each	S.C.C.
unit
P9021	Red blood cells, each unit	S.C.C.
P9022	Red blood cells, washed,	S.C.C.
each unit
P9023	Plasma, pooled multiple,	S.C.C.
donor solvent/detergent
treated, frozen, each unit
P9031	Platelets, leukocytes	S.C.C.
reduced, each unit
P9032	Platelets, irradiated,	S.C.C.
each unit
P9033	Platelets, leukocytes	S.C.C.
reduced, irradiated, each
unit
P9034	Platelets, pheresis, each	S.C.C.
unit
P9035	Platelets, pheresis,	S.C.C.
leukocytes reduced, each unit
P9036	Platelets, pheresis,	S.C.C.
irradiated, each unit
P9037	Platelets, pheresis,	S.C.C.
leukocytes reduced,
irradiated, each unit
P9038	Red blood cells,	S.C.C.
irradiated, each unit
P9039	Red blood cells,	S.C.C.
deglycerolized, each unit
P9040	Red blood cells,	S.C.C.
leukocytes reduced,
irradiated, each unit
P9041	Infusion, albumin (human),	S.C.C.
5%, 50ml
P9043	Infusion, plasma protein	S.C.C.
fraction (human), 5%, 50ml
P9044	Plasma, cryoprecipitate	S.C.C.
reduced, each unit
P9045	Infusion, albumin (human),	S.C.C.
5%, 250 ml
P9046	Infusion, albumin (human),	S.C.C.
25%, 20ml
P9047	Infusion, albumin (human)	S.C.C.
25%, 50ml
P9051	Whole blood or red blood	S.C.C.
cells, leukocytes reduced,
cmv-negative, each unit
P9052	Platelets, hla-matched	S.C.C.
leukocytes reduced,
apheresis/pheresis, each unit
P9053	Platelets, pheresis,	S.C.C.
leukocytes, reduced,
cmv-negative, irradiated each
unit
P9056	Whole blood, leukocytes	S.C.C.
reduced, irradiated, each
unit
P9058	Red blood cells,	S.C.C.
leukocytes reduced, each unit
P9060	Fresh frozen plasma, donor	S.C.C.
retested, each unit
P9604	Prorated trip charge	1.38
P9612	Catheterization for	1.80
collection of urine; all
places of service
P9615	Catheterization for	1.80
collection of (urine)
specimen(s), (multiple)
patients
QUALIFIER: This service is
reimbursable at a fixed rate
or at the amount of the
hospital charge (whichever is
less) per specimen type, per
patient encounter, regardless
of the number of patient
encounters per day.
Q0111	Wet mount, including	2.40
preparations of vaginal,
cervical or skin specimens
Q0112	All potassium hydroxide	2.40
(KOH) preparations
Q0113	Pinworm examination	5.10
Q0114	Fern test	9.60
Q0115	Post-coital direct,	12.33
qualitative examinations of
vaginal or cervical mucous
Q4081	Injection, epoetin alfa,	1.33
100 units (for ESRD on
dialysis)

N.J. Admin. Code § 10:52-10.3

Amended by R.2000 d.29, effective 1/18/2000.
See: 31 N.J.R. 3151(a), 32 N.J.R. 276(a).
In the table, deleted a reference to home bound, nursing and SNF patients in P9610, and deleted W8900, W8920 and W8925.
Amended by R.2005 d.214, effective 7/5/2005.
See: 37 N.J.R. 436(a), 37 N.J.R. 2506(a).
Added HCPCS codes G0027, G0141, G0306, G0307, G0328, P3000, P3001, P9031 through P9034, P9040, P9041, P9043, P9044, P9046, P9604, P9612 and W8900; deleted HCPCS codes G0001, P9610, Q0116, W8200, W8260, W8265, and W8730.
Amended by R.2011 d.010, effective 1/3/2011.
See: 42 N.J.R. 1656(a), 43 N.J.R. 43(a).
Rewrote the table.