N.J. Admin. Code § 10:57-2.3

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

Section 10:57-2.3 - Provisions regarding surgery

(a) Specific requirements for surgery procedures may be found at N.J.A.C. 10:57-3.2(b).

1. Certain surgical procedures are carried out as an integral part of a total service and, as such, do not warrant a separate charge. When such a procedure is carried out as a separate entity not immediately related to other services, the provider may bill a value for Separate Procedure.

2. Complications or other circumstances requiring additional and unusual services concurrent with the procedure(s) or during the listed period of normal follow-up care, may warrant additional reimbursement on a fee-for-service basis.

3. When multiple or bilateral surgical procedures, which add significant time or complexity to patient care, are performed at the same operative session, the total reimbursement shall be the allowance of the primary procedure plus 50 percent of the allowance of the secondary procedures to a total maximum of 200 percent of the primary procedure unless otherwise specified in this section.

4. Anesthesia services rendered to his or her patient by the operating podiatrist are considered part of the surgical procedure and will not receive any additional reimbursement.

5. Reimbursement will be made for an assistant surgeon when the service is medically necessary and when a duly qualified surgical resident or house physician is unavailable, and when the primary procedure performed has a procedure code specialist fee of at least $ 142.00. The allowance permitted is a maximum of 15 percent of the listed specialist fee. The minimum payment is $ 27.00.

N.J. Admin. Code § 10:57-2.3

Amended by R.2001 d.63, effective 2/20/2001.
See: 32 New Jersey Register 4096(a), 33 New Jersey Register 661(b).
In (a)3, inserted "of the primary procedure" following "of 200 percent".