N.J. Admin. Code § 10:75-4.2

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

Section 10:75-4.2 - Billing procedures

(a) Beginning on the date of admission, and for each subsequent whole day that a resident is under the care of the PRTF, the provider shall seek reimbursement using the appropriate HCPCS procedure code as defined in N.J.A.C. 10:75-5.2.

(b) Providers shall request reimbursement for services provided on the date that the resident adult is admitted to the facility, but shall not request reimbursement for services provided on the day that the resident is discharged from the facility. Discharged means that the resident has been discharged from the facility and is not reasonably expected to return to the facility.

(c) Providers may bill for consecutive dates of service on the same claim line, but shall not span dates from more than one month on any given claim lime. Therapeutic and hospital leave days shall be indicated on separate lines and reimbursement shall be requested using the appropriate HCPCS code, as defined in N.J.A.C. 10:75-5.2.

N.J. Admin. Code § 10:75-4.2