N.J. Admin. Code § 10:59-2.1

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

Section 10:59-2.1 - Introduction

(a) The New Jersey Medicaid/NJ FamilyCare Program utilizes the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act, of 1996, 42 USC § 1320d et seq., and incorporated herein by reference, as amended and supplemented, and published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions and replacement codes) will be reflected in this chapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology (CPT) architecture, employing a five-position code and as many as two 2-position modifiers. Unlike the CPT numeric design, the CMS-assigned codes and modifiers contain alphabetic characters. HCPCS was developed as a three-level coding system. Level I codes are not applicable to medical supplies and durable medical equipment. The level II and Level III codes are as follows:

1. LEVEL II CODES (Narratives found at N.J.A.C. 10:59-2.3) are assigned by the Centers for Medicare & Medicaid Services (CMS) for physician and non-physician services which are not in the CPT.

2. LEVEL III CODES (Narratives found in N.J.A.C. 10:59-2.3) are assigned by the Division to be used for those services not identified by CPT codes or CMS-assigned codes. Level III codes identify services unique to New Jersey.

(b) The responsibilities of the provider of durable medical equipment (DME) and medical supply services for rendering services and requesting reimbursement are listed at N.J.A.C. 10:59-1.

N.J. Admin. Code § 10:59-2.1

Amended by R.2001 d.64, effective 2/20/2001.
See: 32 N.J.R. 4098(a), 33 N.J.R. 661(c).
Amended by R.2006 d.297, effective 9/5/2006.
See: 38 N.J.R. 1371(b), 38 N.J.R. 3578(a).
Rewrote the section.