N.J. Admin. Code § 10:54-5.39

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:54-5.39 - Rehabilitative services; separation of therapy and office visit reimbursement

(a) No portion of the time spent on therapy treatments may be considered as part of the time parameters of an office visit. Office visits billed during the same day shall clearly and separately meet the time and other parameters described in the applicable HCPCS procedure codes, N.J.A.C. 10:54-9.

(b) When the same type of rehabilitative service is performed on a Medicaid/NJ FamilyCare beneficiary more than once on the same day, for example, two physical therapy services, reimbursement shall be made for one service only. Likewise, when the treatment performed on a Medicaid/NJ FamilyCare beneficiary is merely a different modality within the same type of rehabilitative service, reimbursement shall be made for only one service per beneficiary per day.

N.J. Admin. Code § 10:54-5.39

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 New Jersey Register 3929(a), 33 New Jersey Register 555(a).
In (b), substituted "beneficiary" for "recipient" throughout.
Amended by R.2003 d.69, effective 2/3/2003.
See: 34 New Jersey Register 3183(a), 35 New Jersey Register 888(a).
In (b), substituted "Medicaid/NJ FamilyCare" for "Medicaid" throughout the paragraph.