N.J. Admin. Code § 10:62-1.9

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:62-1.9 - Office visits

(a) HCPCS 99201, 99202, 99203, 99204, 99205, 99301, 99302, 99303, 99321, 99322 and 99323 are not reimbursable with 92002, 92004, 92012 or 92014 on the same day.

(b) When multiple special ophthalmological services or ophthalmoscopic services are billed on the same day for the same patient in an office setting, reimbursement shall be limited to the highest valued procedure.

(c) When the setting for the initial visit is an office or residential health care facility, for reimbursement purposes it is limited to a single visit. Future use of this category of codes shall be denied when the beneficiary is seen by the same physician, group of physicians, or shared health care facility as defined at N.J.A.C. 10:49-4.1.

(d) Reimbursement for an initial office visit also precludes subsequent reimbursement for an initial residential health care facility visit and vice versa.

N.J. Admin. Code § 10:62-1.9

Amended by 49 N.J.R. 2279(b), effective 7/17/2017