N.J. Admin. Code § 10:54-9.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:54-9.3 - Definitions of modifiers

(a) Services and procedures may be modified under certain circumstances. When applicable, the modifying circumstance should be identified by the addition of alphabetic and/or numeric characters at the end of the code. The New Jersey Medicaid/NJ FamilyCare program's recognized modifier codes are:

Modifier
Code	Description
22	Unusual Services: When the service(s) provided is greater than
that usually required for the listed procedure, it may be
identified by adding modifier '22' to the usual procedure number.
A report with additional documentation must accompany the claim
form to justify the greater services, unusual services or
complications.
26	Professional Component: Certain procedures are a combination of a
physician and a technical component. When the physician component
is reported separately, the service may be identified by adding
the modifier '26' to the usual procedure number. If a professional
component type service is keyed without a '26' modifier and a
manual pricing edit is received, resolve the edit by adding a 26
modifier.
50	Bilateral Procedures: When bilateral procedures are provided at
the same operative session, the first major procedure may be
reported as listed. The second (bilateral) procedure may be
identified by adding the modifier '50' to the usual procedure
number(s).
51	Multiple Procedures: When multiple procedures are performed on the
same day or at the same session, the major procedure or service
may be reported as listed. The secondary additional, or lesser
procedure(s) or service(s) may be identified by adding the
modifier '51' to the secondary procedure or service code(s).
This modifier may be used to report multiple medical procedures
performed at the same session, as well as a combination of
medical and surgical procedures, or several surgical procedures
performed at the same operative session.
52	Reduced Services: Under certain circumstances a service or
procedure is partially reduced at the physician's election.
Under these circumstances the service provided can be identified
by its usual procedure number and the addition of the modifier
'52', signifying that the service is reduced. This provides a
means of reporting reduced services without disturbing the
identification of the basic service.
62	Two Surgeons: Under certain circumstances the skills of two
surgeons (usually with different skills) may be required in the
management of a specific surgical procedure. Under such
circumstances the services of each may be identified by adding
the modifier '62' to the procedure number used by each surgeon
for reporting his services.
66	Surgical Team: Under some circumstance, highly complex procedures
(requiring the concomitant services of several physicians, often
of different specialties, plus other highly skilled, specially
trained personnel and various types of complex equipment) are
carried out under the 'surgical team' concept. Such circumstance
may be identified by each participating physician with the
addition of the modifier '66' to the basic procedure number used
for reporting services.
76	Repeat Procedure by Same Physician: The physician may need to
indicate that a procedure or service was repeated subsequent to
the original service. This may be reported by adding the modifier
'76' to the procedure code of the repeated service.
77	Repeat Procedure by Another Physician: The physician may need to
indicate that a basic procedure performed by another physician had
to be repeated. This may be reported by adding the modifier '77'
to the procedure code of the repeated service.
80	Assistant Surgeon: Surgical assistant services may be identified
by adding the modifier '80' to the basic procedure code.
See N.J.A.C. 10:54-9.2(b).
AA	Anesthesia services personally rendered by anesthesiologist.
AP	Determination of refractive state was not performed in course of
diagnostic ophthalmological examination.
AV	Advanced Practice Nurse.
QW	CLIA waived
TC	Technical component: When applicable, a charge may be made for the
technical component alone. Under those circumstances the technical
component charge is identified by adding the modifier 'TC' to the
usual procedure code.
WB	Second surgical session performed on the same day as an earlier
surgical session.
WF	Family planning.
WM	Midwifery.
WT	Early and Periodic Screening, Diagnosis and Treatment (EPSDT).
WY	Legal abortion-1st trimester.
WZ	Legal abortion-2nd trimester.
YY	Second surgical opinion consultation.
ZZ	Third surgical opinion consultation.

Amended by R.2004 d.334, effective 9/7/2004.
See: 36 N.J.R. 312(a), 36 N.J.R. 4136(a).
Amended by R.2006 d.237, effective 7/3/2006.
See: 38 N.J.R. 907(a), 38 N.J.R. 2803(a).
Updated table in (a).