N.J. Admin. Code § 10:54-5.6

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

Section 10:54-5.6 - Diagnostic endoscopic procedures; with biopsy

(a) For diagnostic endoscopic procedures with biopsies, the pricing logic for multiple surgical procedures applies (see N.J.A.C. 10:54-4.15). In some instances, there is a specific CPT (HCPCS) code associated with that procedure which includes the biopsy and that HCPCS code must be used when requesting reimbursement.

(b) The modifier 22 shall be used with the HCPCS which designates the diagnostic endoscopic procedures with a biopsy when the code does not specifically designate a biopsy. The multiple procedure surgical pricing logic does apply to the reimbursement of these codes. (See also N.J.A.C. 10:54-9.5 under each specific code.)

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 New Jersey Register 3929(a), 33 New Jersey Register 555(a).
In (a), substituted "CPT" for "CPT-4"; in (b), amended the N.J.A.C. reference.