N.J. Admin. Code § 10:66-5.1

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

Section 10:66-5.1 - Covered services

(a) Medicaid and NJ FamilyCare fee-for-service covered procedures in an ambulatory surgical center (ASC) are those surgical and medical procedures that appear at 42 CFR 416.166, the Federal regulations governing ASC services.

(b) Medicaid-covered and NJ FamilyCare fee-for-service covered surgical procedures include, but are not limited to, those procedures that:

1. Are commonly performed in a hospital, but may be safely performed in an ASC;

i. Are not commonly or safely performed in a physician's office;

2. Require a dedicated operating room or suite, and require a postoperative recovery room or short-term, meaning not overnight, convalescent room;

3. Do not generally exceed a total of 90 minutes operating time and four hours recovery or convalescent time; and

4. Are not emergent or life threatening in nature, for example:

i. Do not generally result in extensive blood loss;

ii. Do not require major or prolonged invasion of body cavities; or

iii. Do not directly involve major blood vessels.

(c) For reimbursement information for ASC services, see N.J.A.C. 10:66-1.5.

N.J. Admin. Code § 10:66-5.1

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

Amended by 51 N.J.R. 1056(a), effective 6/17/2019