N.J. Admin. Code § 10:54-6.18

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

Section 10:54-6.18 - Policy for reimbursement for HealthStart providers

(a) The HealthStart HCPCS procedure codes listed in this subchapter are governed by the same policies and rules that appear in the HCPCS subchapter of each chapter concerning non-institutional provider services. (See the Chapters on Independent Clinic Services, (N.J.A.C. 10:66), Physician Services, (N.J.A.C. 10:54)) and the Nurse Midwivery Services, (N.J.A.C. 10:58). The maximum fee allowance schedule and reimbursement requirements for HCPCS HealthStart Maternity Codes (Medical Care and Health Support Services) and HCPCS HealthStart Pediatric Codes are listed under N.J.A.C. 10:49-8.19 and 8.20 respectively.

(b) A HealthStart Provider shall submit the same claim form presently in use for the type of service provided.

Physician services CMS 1500 Claim Form

Nurse Midwifery services CMS 1500 Claim Form

Independent clinics CMS 1500 Claim Form

Local Health Departments CMS 1500 Claim Form

Hospital Outpatient Departments--Use present procedure for billing except for HealthStart Health Support Services (W9040-W9043) and the HealthStart Pediatric Continuity of Care (W9070), which are billed on the CMS 1500 Claim Form.

N.J. Admin. Code § 10:54-6.18

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 table in (b) and in the paragraph following the table in (b), substituted "CMS" for "HCFA" throughout; and in the paragraph following the table in (b), inserted a comma following "(W9070)" and substituted "Claim Form" for "claim form".