N.J. Admin. Code § 10:54-6.19

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

Section 10:54-6.19 - HealthStart maternity care code requirements

(a) HealthStart Maternity Care code requirements are as follows:

1. Separate reimbursement shall be available for Maternity Medical Care Services and Maternity Health Support Services;

2. Maternity Medical Care Services shall be billed as a total obstetrical package, when feasible, but may be billed as separate procedures;

3. The enhanced reimbursement for the delivery and postpartum care may be claimed only for a patient who had received at least one antepartum HealthStart Maternity Medical or Health Support Service;

4. The modifier "WM" in the HCPCS list of procedure codes refers to those services provided by certified nurse midwives who shall include the modifier at the end of each code; and

5. Laboratory and other diagnostic procedures and all necessary medical consultations shall be eligible for separate reimbursement.

(b) HealthStart Maternity Medical Care procedure codes are provided in N.J.A.C. 10:54-9.10(k) and (l), Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System (HCPCS).

N.J. Admin. Code § 10:54-6.19

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)1, (a)2 and (a)3, substituted a semicolon for a period at the end; in (a)4, substituted "; and" for a period at the end; and in (b), substituted "Centers for Medicare and Medicaid Services Healthcare" for "Health Care Financing Administration".