N.J. Admin. Code § 10:67-1.5

Current through Register Vol. 57, No. 1, January 6, 2025
Section 10:67-1.5 - Basis of reimbursement
(a) Psychological services shall be reimbursed at the lesser of the psychologist's charges or the amount in the Maximum Fee Allowance Schedule for psychological services. (See N.J.A.C. 10:67-3.2 for the Maximum Fee Allowance Schedule.)
(b) The Maximum Fee Allowance Schedule is based on the Healthcare Common Procedure Coding System (HCPCS). For HCPCS codes and Maximum Fee Allowance Schedule, see N.J.A.C. 10:67-3. For billing instructions, see the Fiscal Agent Billing Supplement. For instructions on how to obtain a copy of the Fiscal Agent Billing Supplement see the Appendix of this chapter.
(c) In no event shall the provider's charge to the New Jersey Medicaid/NJ FamilyCare program exceed the charge for services rendered by the provider for identical services to other governmental agencies, or other groups or individuals in the community.

N.J. Admin. Code § 10:67-1.5

Amended by R.2006 d.348, effective 10/2/2006.
See: 38 N.J.R. 2007(a), 38 N.J.R. 4219(b).
In (a) and (b), deleted "Medicaid" preceding "Maximum Fee Allowance Schedule"; in (b), substituted "Healthcare" for "Health Care Financing Administration"; and in (c), inserted "NJ FamilyCare"
Amended by 53 N.J.R. 2224(a), effective 12/20/2021