N.J. Admin. Code § 10:52-3.17

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

Section 10:52-3.17 - HealthStart Maternity Care billing code requirements

(a) HealthStart Maternity Care billing code requirements shall be as follows:

1. Separate reimbursement shall be available for maternity medical care services and maternity health support services.

2. Maternity medical care services shall be billed as a total obstetrical package, when applicable, but may be billed as separate procedures.

3. The enhanced reimbursement for the delivery and postpartum care may be claimed only for a patient who had received at least one antepartum HealthStart maternity medical or health support service.

4. The modifier "WM" in the HCPCS lists of codes (W9025 through W9030) refers to those services provided by certified nurse midwives who shall include the modifier at the end of each code. HCPCS codes for health support services do not require the "WM" modifier on HCPCS codes W9040 and W9043.

5. Laboratory and other diagnostic procedures and all necessary medical consultations shall be eligible for separate reimbursement.

(b) HealthStart maternity medical care procedure codes are provided in N.J.A.C. 10:66-6, the Healthcare Common Procedure Coding System (HCPCS) for Independent Clinic Services.

N.J. Admin. Code § 10:52-3.17

Amended by R.2005 d.214, effective 7/5/2005.
See: 37 New Jersey Register 436(a), 37 New Jersey Register 2506(a).
In (a), substituted "applicable" for "feasible" preceding ", but may be billed" in 2; rewrote (b).