N.J. Admin. Code § 10:61-2.2

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:61-2.2 - Specific services

(a) The sum of any number of the components of a battery of tests shall not exceed the total charged for the group offering (panel or profile), whether done by automation or bench testing, whether or not the equipment is available in the facility. A battery of tests is considered to be those components of a panel or series of tests which, when combined, mathematically or otherwise, comprise a finished identifiable laboratory study or studies. Examples are:

1. The components of a metabolic profile or other automated laboratory study;

2. An MCH, MCV, or other test, as a component of a C.B.C.;

3. Inclusive of all ova and parasites in a stool examination.

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

(c) In no instance shall reimbursement exceed the Medicare Fee Schedule.

(d) Where tests are referred by an approved service laboratory to an approved reference laboratory, the approved reference laboratory shall be a Medicaid/NJ FamilyCare provider and shall directly bill the Medicaid/NJ FamilyCare program for the service.

1. The initiating laboratory shall only refer clinical laboratory tests to laboratories which have a valid CLIA Identification Number and are Medicaid/NJ FamilyCare approved providers.

(e) The policy on reimbursement for visits to the nursing home, residential health care facility, or to the beneficiary's home by an independent lab for the purposes of obtaining blood by venous or arterial puncture is as follows:

1. Utilize HCPCS code W8900 for visits to homebound beneficiaries in their own home or living in a residential health care facility, group home, or boarding home. This code may be used only once per trip regardless of the number of patients seen and requires a distance in excess of 20 miles per round trip.

2. Utilize HCPCS code 36415 for a visit to a beneficiary in a nursing facility, or Intermediate Care Facility/Mental Retardation (ICF/MR).

3. Reimbursement will not be made for travel to other sites including, but not limited to, hospitals, physician offices, or clinics.

N.J. Admin. Code § 10:61-2.2

Amended by R.2001 d.79, effective 3/5/2001.
See: 32 New Jersey Register 4167(a), 33 New Jersey Register 781(c).
In (a)1, substituted "metabolic" for "chemistry".
Amended by R.2006 d.37, effective 1/17/2006.
See: 37 New Jersey Register 3182(a), 38 New Jersey Register 807(a).
In introductory paragraph (a), deleted "Where batteries constitute a profile, they shall be billed in that manner." and substituted "panel" for "test"; in (b) and introductory paragraph (d), added "NJ FamilyCare" following "Medicaid/" throughout; in (b), added "panel or" preceding "profile"; in (d)1, deleted "New Jersey"; and rewrote (e)2.