Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 54 - PHYSICIAN SERVICES
Subchapter 3 - PROVISION OF SERVICES
Section 10:54-3.1 - Medical Justification Program

N.J. Admin. Code § 10:54-3.1

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Current through Register Vol. 56, No. 21, November 4, 2024
Section 10:54-3.1 - Medical Justification Program
(a) The Medical Justification Program of the New Jersey Medicaid/NJ FamilyCare program defines certain surgical and diagnostic procedures that are reimbursable only when acceptable written justification by the physician accompanies the claim form. The procedures that require medical justification are identified in the Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedures Coding System by the indicator "M" preceding the HCPCS code. (See N.J.A.C. 10:54-9.)
(b) Physicians shall maintain written records that substantiate the use of a given procedure code. These records shall be available for review and/or inspection if requested by the New Jersey Medicaid/NJ FamilyCare program.

N.J. Admin. Code § 10:54-3.1

Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In (a) and (b), inserted "/NJ FamilyCare"; and in (a), substituted "Program" for the first occurrence of "program", "that" for "which" twice and "Centers for Medicare and Medicaid Services (CMS) Healthcare" for "HCFA".