N.J. Admin. Code § 10:55-2.1

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

Section 10:55-2.1 - Introduction

(a) The New Jersey Medicaid NJ FamilyCare fee-for-service programs have adopted the Centers for Medicare and Medicaid's Healthcare Common Procedure Coding System (HCPCS). The HCPCS procedure codes listed in this subchapter shall be used when filing a claim for prosthetic and/or orthotic services.

1. The responsibility of the prosthetic and orthotic services provider when rendering services and requesting reimbursement is listed in N.J.A.C. 10:55-1 of the Prosthetic and Orthotic Services chapter.

(b) The New Jersey Medicaid/NJ FamilyCare fee-for-service programs utilize the Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS) for 2009, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, Pub.L. 104-191, and incorporated herein by reference, as amended and supplemented, and as published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions, and replacement codes) will be reflected in this subchapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. HCPCS follows the American Medical Association's Physicians' Current Procedure Terminology (CPT) architecture, employing a five-position code and as many as two two-position modifiers. Unlike the CPT numeric design, the CMS-assigned codes and modifiers contain alphabetic characters.

1. Level I codes (narratives found in CPT): These codes are adapted from CPT for utilization primarily by physicians, podiatrists, optometrists, certified nurse-midwives, independent clinics and independent laboratories. CPT is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures performed by physicians. Copyright restrictions make it impossible to print excerpts from CPT procedure narratives for Level I codes. In order to determine those narratives it is necessary to refer to CPT, which is incorporated herein by reference, as amended and supplemented. An updated copy of the CPT (Level I) codes may be obtained from the American Medical Association, P.O. Box 10950, Chicago, IL 60610, or by accessing www.ama-assn.org.

2. Level II codes: These codes are assigned by CMS for physician and non-physician services that are not in CPT. An updated copy of the HCPCS (Level II) codes may be obtained by accessing the HCPCS website at www.cms.hhs.gov/TransactionCodeSetsStands/or by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010.

N.J. Admin. Code § 10:55-2.1

Amended by R.2000 d.134, effective 4/3/2000.
See: 31 N.J.R. 3964(a), 32 N.J.R. 1206(a).
In (a), substituted a reference to Medicaid and NJ KidCare fee-for-service programs for a reference to programs in the introductory paragraph.
Amended by R.2004 d.406, effective 11/1/2004.
See: 35 N.J.R. 4417(a), 36 N.J.R. 4963(a).
In (a), substituted "Centers for Medicare and Medicaid's Healthcare" for "Health Care Financing Administration's (NCFA)" in the introductory paragraph.
Amended by R.2011 d.080, effective 3/7/2011.
See: 42 N.J.R. 2179(a), 43 N.J.R. 622(a).
Added (b).

Amended by 56 N.J.R. 2189(b), effective 11/4/2024