Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 77 - REHABILITATIVE SERVICES FOR CHILDREN
Subchapter 7 - CENTERS FOR MEDICARE & MEDICAID SERVICES' HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:77-7.2 - HCPCS procedure code numbers and maximum fee allowance schedule

N.J. Admin. Code § 10:77-7.2

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Current through Register Vol. 57, No. 1, January 6, 2025
Section 10:77-7.2 - HCPCS procedure code numbers and maximum fee allowance schedule
(a) Environmental Lead Inspection Codes:

HCPCS CodeDescriptionMaximum Fee Allowance
Y 9733Initial Inspection for Lead$ 260.00
Y 9734Reinspection for Lead100.00
Qualifier: Limit of two reinspections per
primary residence per family

(b) Mental Health Rehabilitation Services provided in psychiatric community residences for youth, group homes, or residential childcare facilities:

INDHCPCS CodeMOD Procedure Code DefinitionMaximum Fee Allowance
PH0018TJMobile Response-Crisis Bed. For services rendered in psychiatric community residences for youth, group homes or residential childcare facilities to a child, youth or young adult receiving mobile response and stabilization management services (per diem, not to exceed seven days) $ 50.00 per diem
Y9933 Mental health rehabilitation services provided in non-JCAHO accredited residential treatment centers licensed as community psychiatric residences for youth licensed by the Division of Mental Health and Addiction Services, under N.J.A.C. 10:128 Contract pricing
Y9934 Mental health rehabilitation services provided in therapeutic foster care facilities, licensed by the Division of Child Protection and Permanency, that contract with the Division of Mental Health and Addiction Services under N.J.A.C. 10:128. Contract pricing
Y9935 Mental health rehabilitation services provided in group homes (serving six to 12 children) licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. Contract pricing
Y9936 Mental health rehabilitation services provided in supervised transitional living homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. Contract pricing
Y9937 Mental health rehabilitation services provided in teaching family homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. Contract pricing
Y9938 Mental health rehabilitation services provided in treatment homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. Contract Pricing
Y9939 Mental health rehabilitation services provided in alternative care homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. Contract pricing
Y9943 Mental health rehabilitation services provided in non-JCAHO residential child care facilities licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:127. Contract pricing
Y9944 Room and board for mental health rehabilitation services provided in facilities under contract with the Division of Child Protection and Permanency, under N.J.A.C. 10:127 and 10:128. Contract pricing
Y9945 Room and board for mental health rehabilitation services provided in facilities under contract with the Division of Mental Health and Addiction Services, under N.J.A.C. 10:128. Contract pricing
Y9946All other room and board for mental health rehabilitation services.Contract pricing
Y9947 Mental health rehabilitation services provided in JCAHO accredited RTCs licensed by the Division of Mental Health and Addiction Services (DMHAS), under N.J.A.C. 10:128. Contract pricing
Y9948 Mental health rehabilitation services provided in JCAHO accredited RTCs licensed by the Division of Child Protection and Permanency (DCP&P), under N.J.A.C. 10:127. Contract pricing
Y9992 Therapeutic Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DMHAS Contract pricing
Y9993 Therapeutic Leave for Room and Board Board Services provided in non-JCAHO accredited facilities under contract with DMHAS Contract pricing
Y9994 Hospital Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DMHAS Contract pricing
Y9995 Hospital Leave for Room and Board Services provided in non-JCAHO accredited facilities under contract with DMHAS Contract pricing
Y9996 Therapeutic Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DCP&P Contract pricing
Y9997 Therapeutic Leave for Room and Board Board Services provided in non-JCAHO accredited facilities under contract with DCP&P Contract pricing
Y9998 Hospital Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DCP&P Contract pricing
Y9999 Hospital Leave for Room and Board Services provided in non-JCAHO accredited facilities under contract with DCP&P Contract pricing

(c) Behavioral Assistance Services Codes:

IND HCPCS Code MOD Procedure Code Definition Maximum Fee Allowance
P H2014 TJ Individual behavioral assistance services. (15-minute unit of service) $18.19/unit
PH2014TJ UN Group behavioral assistance services. Services are limited to those provided directly to, or in support of, two children/youth or young adults. (15-minute unit of service) $11.10/unit per child
P H2014 TJ UP Group behavioral assistance services. Services are limited to those provided directly to or in support of three children/youth or young adults. (15-minute unit of service) $30.83/unit per child
PS5125TJIndividual behavioral assistance services in non-Title XIX eligible locations. (15-minute unit of service)$ 9.75 ($ 39.00 per hour)
PS5125 TJ UNSmall group behavioral assistance services in non-Title XIX eligible locations. Services are limited to those provided directly or in support of two children/youth or young adults. (15-minute unit of service)$ 5.62/unit per child
PS5125TJ UPSmall group behavioral assistance services in non-Title XIX eligible locations. Services are limited to those provided directly or in support of three children/youth or young adults. (15-minute unit of service) $ 4.25/unit per child

(d) Mobile response and stabilization management services codes:

IND HCPCS Code MOD Procedure Code Definition Maximum Fee Allowance
P S9485 TJ Mobile Response-Initial (one unit of service per episode, not to exceed 72 hours, spanning up to four days) $1,320 per unit of service
P H0032 TJ Mobile Response-Care Coordination and Stabilization Plan (15 minute units of service, not to exceed a total of 64 units or 16 hours, up to eight weeks as authorized weekly) $8.40 per unit of service

(e) Intensive in-community mental health rehabilitation services:

IND HCPCS Code MOD 1&2 Procedure Code Definition Maximum Fee Allowance
PH0036TJ U3Supportive service level (intensive in-community services delivered by, at a minimum, a bachelor's level direct care provider) Individual, 15 minute units of service$ 18.25 per unit of service. ($ 73.00 per hour)
P H0036 TJ U2 Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Individual, 15-minute unit of service $28.74 per unit of service. ($114.96 per hour)
PH0036TJ HQProfessional service level (intensive in-community services delivered by, at a minimum, a master's level direct care provider) Group, 15 minute units of serviceContract Pricing
P H0036 TJ U1 Clinical level services(intensive in-community services delivered by a licensed behavioral health care practitioner) Individual, 15-minute unit of service $30.83 per unit of service ($123.32 per hour)
P H0036 U1 UN Clinical level services (intensive in-community services delivered by a licensed behavioral healthcare practitioner) Group services provided directly to, or in support of, two children, youth or young adults, 15-minute unit of service. $20.17/unit per child
P H0036 U2 UN Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Group services provided directly to, or in support of, two children, youth, or young adults, 15-minute unit of service $18.45/unit per child
P H0036 U1 UP Clinical level services (intensive in-community services delivered by a licensed behavioral healthcare practitioner) Group services provided directly to, or in support of, three children, youth, or young adults, 15-minute unit of service. $17.45/unit per child
P H0036 U2 UP Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Group services provided directly to, or in support of, three children, youth, or young adults, 15-minute unit of services $15.02/unit per child

N.J. Admin. Code § 10:77-7.2

Amended by 48 N.J.R. 81(a), effective 1/4/2016
Amended by 55 N.J.R. 1292(a), effective 6/19/2023