N.J. Admin. Code § 10:58-2.10

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

Section 10:58-2.10 - Clinical laboratory services provided by a CNM

(a) A CNM may claim reimbursement for clinical laboratory services performed for his or her own patients within his or her own office, except when provided in a birth center. Laboratory services provided in a birth center shall be billed to Medicaid/NJ FamilyCare-Plan A fee-for-service programs by the center.

1. A CNM shall meet the conditions of the CLIA regulations before she or he may perform clinical laboratory testing for Medicaid/NJ FamilyCare-Plan A fee-for-service beneficiaries; and

2. The clinical laboratory tests shall be standard clinical laboratory procedures consistent with the CNM's CLIA certification, certificate of waiver or certificate of registration.

(b) Profiles are components of a test or series of tests which are frequently performed or automated. Examples of identifiable laboratory profiles or studies are as follow:

1. Obstetrical Profile;

2. The components of an SMA (Sequential Multichannel Automated Analysis) 12/60 or other automated laboratory study; or

3. Inclusion of blood indices, such as MCH (Mean Corpuscular Hemoglobin), MCV (Mean Corpuscular Volume), as a component of a CBC (Complete Blood Count).

(c) If the components of a profile are billed separately, reimbursement for the components of the profile (panel) shall not exceed the Medicaid/NJ FamilyCare fee allowance for the profile itself.

N.J. Admin. Code § 10:58-2.10

Amended by R.1998 d.209, effective 5/4/1998.
See: 30 N.J.R. 57(a), 30 N.J.R. 1613(a).
In (a), rewrote first sentence and added a new second sentence; and added (b) and (c).
Amended by R.2001 d.204, effective 6/18/2001.
See: 33 N.J.R. 1160(a), 33 N.J.R. 2188(a).
In (a), inserted "NJ FamilyCare-Plan A fee-for-service programs" following "Medicaid" in the introductory paragraph and in 1, substituted "NJ Family Care-Plan A fee-for-service beneficiaries" for "recipients".

Amended by 53 N.J.R. 1843(c), effective 11/1/2021