N.J. Admin. Code § 10:52-10.5

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

Section 10:52-10.5 - Pathology and Laboratory HCPCS Codes-Modifiers

(a) Services and procedures may be modified under certain circumstances. When applicable, the modifying circumstance has been identified by the addition of alphabetic and/or numeric characters at the end of the code. The New Jersey Medicaid/NJ FamilyCare fee-for-service programs' recognized modifier codes are:

Modifier
Code	Description
22	Unusual Procedural Services: When the service(s) provided
is greater than that usually required for the listed
procedure, it may be identified by adding modifier '22'
to the usual procedure number. A report may also be
appropriate.
26	Professional Component: Certain procedures are a
combination of a physician component and a technical
component. When the physician component is reported
separately, the service may be identified by adding the
modifier '26' to the usual procedure number.
52	Reduced Services: Under certain circumstances a service
or procedure is partially reduced or eliminated at the
physician's election. Under these circumstances the
service provided can be identified by its usual procedure
number and the addition of the modifier '52', signifying
that the service is reduced. This provides a means of
reporting reduced services without disturbing the
identification of the basic service.
90	Reference (Outside) Laboratory: When laboratory
procedures are performed by a party other than the
treating or reporting physician, the procedure may be
identified by adding the modifier '90' to the usual
procedure number.

Amended by 50 N.J.R. 1261(a), effective 5/21/2018