N.J. Admin. Code § 10:54-5.15

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:54-5.15 - Family planning services

(a) Payment shall be made for medically necessary family planning services, including medical history and physical examination (including pelvis and breast), diagnostic and laboratory tests, drugs and biologicals, medical supplies and devices, counseling, continuing medical supervision, continuity of care and genetic counseling.

(b) Services provided primarily for the diagnosis and treatment of infertility, including sterilization reversals and related office visit, drugs, laboratory services, radiological and diagnostic services and surgical procedures are not covered by the New Jersey Medicaid/NJ FamilyCare program, except:

1. When a service is provided that is ordinarily considered an infertility service, but is provided for another purpose. In such case, the physician shall submit the claim with supporting documentation for medical review and approval of payment to the Division of Medical Assistance and Health Services, Office of Utilization Management, PO Box 712, Mail Code #14, Trenton, New Jersey 08625-0712.

N.J. Admin. Code § 10:54-5.15

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (b)1, substituted "Utilization Management" for "Health Services Administration" in the second sentence; in (c)5, substituted "beneficiary" for "recipient" preceding "are permitted".
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In the introductory paragraph of (b), deleted a comma following "reversals" and the second occurrence of "services", and inserted "/NJ FamilyCare"; and deleted (c).