N.J. Admin. Code § 10:66-5.3

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

Section 10:66-5.3 - Facility services

(a) Facility services include, but are not limited to:

1. Nursing services, services of technical personnel, and other related services;

2. The use by the patient of the ASC's facilities;

3. Drugs, biologicals, surgical dressings, supplies, splints, casts, appliances and equipment commonly furnished in connection with a surgical procedure. Drugs and biologicals are limited to those which cannot be self administered;

4. Diagnostic or therapeutic items and services furnished by ASC staff in connection with a covered surgical procedure, for example, simple tests such as urinalysis, blood hemoglobin, or hematocrit, administered in conjunction with the surgical procedure;

5. Administrative, recordkeeping and housekeeping items and services;

6. Blood, blood plasma, platelets, etc.; and

7. Material for anesthesia.

(b) ASC facility services do not include medical or other health services for which payment could be made under other provisions of the Medicaid and NJ FamilyCare fee-for-service programs, such as laboratory, x-ray, or diagnostic procedures, other than those directly related to performance of the surgical procedure. Examples of items or services that are not ASC facility services include:

1. Physicians' services;

2. The sale, lease, or rental of durable medical equipment to ASC patients for use in their homes;

3. Prosthetic devices (including artificial legs and arms);

4. Transportation services;

5. Leg, arm, back, and neck braces;

6. Artificial eyes; and

7. Services furnished by an independent clinical laboratory.

N.J. Admin. Code § 10:66-5.3

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