N.J. Admin. Code § 10:58-2.16

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:58-2.16 - HealthStart maternity and pediatric services

(a) The purpose of HealthStart is to provide comprehensive maternity and child health care services for all pregnant women (including those determined to be presumptively eligible) and for children (under two years of age) in the State of New Jersey who are eligible for Medicaid benefits. For reimbursement for certified nurse midwives billing independently, refer to 10:58-3.2 and 3.5. For other requirements regarding HealthStart in any setting, refer to the Independent Clinic Services chapter, N.J.A.C. 10:66-3. The CNM shall not become a HealthStart Pediatric Care provider. The CNM shall be an EPSDT provider for adolescent Medicaid recipients. (See 10:58-2.2 for EPSDT services.)

(b) Separate reimbursement is available for HealthStart Maternity Care and Health Support Services procedure codes.

(c) Maternity medical care services should be billed as a total obstetrical package, when feasible, but may be billed as separate procedures.

(d) The enhanced reimbursement for the delivery and postpartum care may be claimed only for a patient who had received at least one antepartum HealthStart Maternity Care visit and had at least one health support services visit.

(e) The modifier "WM" accompanying any given procedure code in the HCPCS list of codes refers to those services provided by CNM and the modifier shall be included at the end of each code when billing for CNM services.

N.J. Admin. Code § 10:58-2.16