Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 73 - CASE MANAGEMENT SERVICES
Subchapter 5 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM
Section 10:73-5.1 - Introduction

N.J. Admin. Code § 10:73-5.1

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Current through Register Vol. 56, No. 23, December 2, 2024
Section 10:73-5.1 - Introduction
(a) The New Jersey Medicaid/NJ FamilyCare program adopted the Centers for Medicare & Medicaid Services Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, and incorporated herein by reference, as amended and supplemented, and published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions, and replacement codes) will be reflected in this chapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1et seq. The HCPCS codes as listed in this subchapter are relevant to Medicaid/NJ FamilyCare adult case management services, Medicaid/NJ FamilyCare/CSOC YCM services and care management organization services and must be used when filing a claim.
1. The responsibilities of the case management services provider when rendering adult case management services are listed in N.J.A.C. 10:73-2.
2. The responsibilities of the care management organization services provider when rendering services are listed in N.J.A.C. 10:73-3.
3. The responsibilities of the case management services provider when rendering youth case management services are listed in N.J.A.C. 10:73-4.
4. "P" is listed under Ind (indicator) which means that prior authorization is required.
5. "TJ" is listed under Mod (modifier) which means that service is rendered for children.

N.J. Admin. Code § 10:73-5.1

Amended by R.1994 d.585, effective 11/21/1994 (operative December 1, 1994).
See: 26 N.J.R. 3350(a), 26 N.J.R. 4614(a).
Amended by R.1996 d.363, effective 8/5/1996.
See: 28 N.J.R. 1977(a), 28 N.J.R. 3788(a).
Amended by R.2001 d.198, effective 6/18/2001.
See: 33 N.J.R. 978(a), 33 N.J.R. 2193(a).
Amended by R.2001 d.475, effective 12/17/2001.
See: 33 N.J.R. 349(a), 33 N.J.R. 1167(a), 33 N.J.R. 4357(a).
In (a), rewrote the second sentence of the introductory paragraph, added 2 and recodified former 2 through 4 as 3 through 5.
Recodified from N.J.A.C. 10:73-4.1 and amended by R.2005 d.78, effective 2/22/2005.
See: 36 N.J.R. 1271(b), 37 N.J.R. 651(a).
In (a), inserted "youth" following "Medicaid/NJ FamilyCare/Partnership for Children" in the introductory paragraph, added 3, recodified former 3 and 4 as 4 and 5 and deleted 5.
Amended by R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Rewrote the introductory paragraph of (a); and in (a)5, substituted "'TJ'" for "'ZC'".
Amended by 53 N.J.R. 1492(a), effective 9/7/2021