N.J. Admin. Code § 10:58A-2.8

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

Section 10:58A-2.8 - Family planning services

(a) Family planning services include medical history and physical examination (including pelvic and breast); the ordering of diagnostic and laboratory tests; the prescribing of drugs and biologicals, medical devices and supplies; and providing continued medical supervision, counseling, and continuity of care.

1. The New Jersey Medicaid/NJ FamilyCare fee-for-service programs shall not reimburse for services for the diagnosis or treatment of infertility. Services provided primarily for the diagnosis and treatment of infertility, including related office visits, drugs, laboratory services, radiological and diagnostic services, and surgical procedures shall not be covered by the New Jersey Medicaid/NJ FamilyCare fee-for-service program.

i. Exception: When a service is provided that is ordinarily considered an infertility service, but is provided for another purpose, the APN shall submit the claim with supporting documentation for medical review and approval of payment to the Division of Medical Assistance and Health Services, Office of Utilization Management, PO Box 712, (Mail Code #14), Trenton, New Jersey 08625-0712.

ii. When a prescription drug is provided that is ordinarily used for infertility, but is provided for medical conditions unrelated to infertility, the clinical practitioner who prescribes this drug should clearly indicate on the prescription that the drug is being provided for a condition other than infertility, and provide a copy of this documentation to the pharmaceutical provider.

N.J. Admin. Code § 10:58A-2.8

Recodified from N.J.A.C. 10:58A-2.7 by R.1999 d.232, effective 7/19/1999 (operative September 1, 1999).
See: 31 New Jersey Register 245(a), 31 New Jersey Register 1956(a).
Former N.J.A.C. 10:58A-2.8, Mental health services, recodified to N.J.A.C. 10:58A-2.9.
Amended by R.2000 d.265, effective 7/3/2000.
See: 32 New Jersey Register 1127(a), 32 New Jersey Register 2483(a).
Rewrote the section.
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 New Jersey Register 312(a), 36 New Jersey Register 4136(a).
Amended by R.2004 d.409, effective 11/1/2004.
See: 35 New Jersey Register 4977(a), 36 New Jersey Register 4968(a).
Amended by R.2005 d.406, effective 11/21/2005.
See: 37 New Jersey Register 2329(a), 37 New Jersey Register 4445(a).
In (a)1ii, added "clinical" preceding "practitioner"; deleted (b).

Amended by 56 N.J.R. 2191(a), effective 11/4/2024