Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 1 - DENTAL SERVICES; GENERAL PROVISIONS
Section 10:56-1.8 - Non-covered services

N.J. Admin. Code § 10:56-1.8

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Current through Register Vol. 56, No. 11, June 3, 2024
Section 10:56-1.8 - Non-covered services
(a) A non-covered service is that procedure which is primarily for cosmetic purposes, for which dental necessity cannot be demonstrated, or which is determined to be beyond the scope of the program by a Medicaid/NJ FamilyCare dental consultant as specified in this chapter.
(b) Medical/dental supplies and equipment and other devices that are essential for the beneficiary's medical/dental condition shall be allowable unless such services are otherwise available at no charge from community services (such as the American Cancer Society or other service organizations).
(c) Standard tooth brushes, dental floss, and like items are considered personal hygiene items and shall not be covered by the Medicaid/NJ FamilyCare fee-for-service program.

N.J. Admin. Code § 10:56-1.8

Amended by R.1974 d.53, effective 3/15/1974.
See: 6 N.J.R. 13(a), 6 N.J.R. 150(b).
Amended by R.1992 d.98, effective 3/2/1992.
See: 23 N.J.R. 281(a), 23 N.J.R. 1310(a), 24 N.J.R. 845(a).
Added subsection (b) on bundled drug services.
Recodified from 10:56-1.4 and amended by R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Former N.J.A.C. 10:56-1.7, "Utilization review, quality control and peer review", recodified to 10:56-1.9.
Recodified from N.J.A.C. 10:56-1.7 by R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 N.J.R. 1060(a).
Former N.J.A.C. 10:56-1.8, Recordkeeping requirements, recodified to N.J.A.C. 10:56-1.9.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 N.J.R. 1060(a), 30 N.J.R. 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.2004 d.25, effective 1/20/2004.
See: 35 N.J.R. 4032(a), 36 N.J.R. 568(a).
In (a), inserted reference to NJ FamilyCare.
Amended by R.2007 d.36, effective 2/5/2007.
See: 38 N.J.R. 3419(a), 39 N.J.R. 479(a).
In (b), substituted "beneficiary's" for "recipient's" and "shall be" for "are" preceding "allowable", and inserted "such services are"; and in (c), substituted "shall not be" for "are not" and "Medicaid/NJ FamilyCare fee-for-service program" for "Program".