N.J. Admin. Code § 10:68-1.5

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

Section 10:68-1.5 - Basis of reimbursement

(a) Reimbursement for covered chiropractic services provided to a Medicaid/NJ FamilyCare beneficiary is provided on the basis of the customary charge (fee-for-service) not to exceed an allowance determined reasonable by the Commissioner of the New Jersey State Department of Human Services and contained at N.J.A.C. 10:68-3.2.

1. In no event shall the charge to the New Jersey Medicaid/NJ FamilyCare program exceed the charge by the provider for identical services to other governmental agencies, or other groups or individuals in the community.

2. The chiropractor may be reimbursed for an initial diagnostic and/or evaluation visit in the absence of manipulation of the spine performed during that visit.

3. The procedure codes that are used when submitting claims are listed at N.J.A.C. 10:68-3.2, Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS). The Fiscal Agent Billing Supplement, incorporated herein by reference, provides information about the claim form and billing instructions. Claims for services rendered shall be submitted by providers in accordance with the Fiscal Agent Billing Supplement. Instructions on how to obtain a copy of the Fiscal Agent Billing Supplement can be found at N.J.A.C. 10:68 Appendix A.

(b) Reimbursement shall not be made for broken appointments, nor shall the provider ask the beneficiary to pay for broken appointments.

N.J. Admin. Code § 10:68-1.5

Amended by R.2000 d.451, effective 11/6/2000.
See: 32 N.J.R. 2691(a), 32 N.J.R. 3992(b).
In (a), added "or NJ KidCare" following "Medicaid" throughout.
Amended by R.2001 d.184, effective 6/4/2001.
See: 33 N.J.R. 976(a), 33 N.J.R. 1918(a).
In (a)2, deleted the last sentence.
Amended by R.2006 d.416, effective 12/4/2006.
See: 38 N.J.R. 2012(a), 38 N.J.R. 5157(a).
In the introductory paragraph of (a), inserted "or NJ FamilyCare" and substituted "Commissioner" for "Commission"; in (a)1, substituted "FamilyCare" for "KidCare"; and in (a)3, substituted "Centers for Medicare & Medicaid Services (CMS) Healthcare" for "Health Care Financing Administration (HCFA)".

Amended by 53 N.J.R. 1788(a), effective 10/18/2021