N.J. Admin. Code § 10:66-2.16

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

Section 10:66-2.16 - Termination of pregnancy

(a) Termination of pregnancy is a Medicaid and NJ FamilyCare fee-for-service-covered service when the following conditions are present:

1. The procedure is performed in an appropriately licensed ambulatory care facility, an ambulatory surgical center, or an ambulatory care/family planning/surgical facility licensed and authorized by the New Jersey State Department of Health to perform terminations of pregnancy with specific approval of the New Jersey Medicaid or NJ FamilyCare program;

2. The procedure is performed in accordance with the requirements of the New Jersey Board of Medical Examiners, N.J.A.C. 13:35;

3. The procedure is performed by a physician licensed to practice medicine and surgery in the State of New Jersey; and

4. The procedure is medically necessary. A physician may take the following factors into consideration in determining whether a termination of pregnancy is medically necessary:

i. To save the life of the mother;

ii. The pregnancy was the result of an act of rape;

iii. The pregnancy was the result of an act of incest;

iv. Physical, emotional, and psychological factors;

v. Family reasons; and

vi. Age.

(b) Claims for termination of pregnancy services are hard-copy restricted; electronic billing is not permitted.

(c) A Physician Certification (Form FD-179) shall be completed, signed and attached to any Medicaid or NJ FamilyCare fee-for-service claim form relating to termination of pregnancy services.

1. The Fiscal Agent Billing Supplement contains a sample Physician Certification (Form FD-179) and item-by-item instructions for the form's proper completion.

N.J. Admin. Code § 10:66-2.16

Amended by 49 N.J.R. 1405(a), effective 6/5/2017