N.J. Admin. Code § 10:55-2.2

Current through Register Vol. 56, No. 16, August 19, 2024

Section 10:55-2.2 - Elements of HCPCS Coding System

(a) The list of HCPCS procedure codes in 10:55-2.3 and 2.4 is arranged in tabular form with specific information for each code given under columns with the titles "HCPCS Code," "Description," and "Maximum Fee Allowance."

(b) The column titled "MAXIMUM FEE ALLOWANCE" indicates the maximum amount of reimbursement or the following symbol:

1. Where "B.R." (By Report) is listed instead of a dollar amount, it means that additional information will be required in order to properly evaluate the service. In such instances, the provider shall attach a copy of the report to the claim form.

(c) Services and procedures may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of alphabetic and/or numeric characters at the end of the HCPCS procedure code. The New Jersey Medicaid NJ FamilyCare fee-for-service program's recognized modifier codes for prosthetic and orthotic services are as follows:

1. "RP" (Repair and/or Replacement) is used to indicate repair and/or replacement of prosthetic and orthotic devices. The claim shows the HCPCS procedure code for the repairs and/or parts, followed by the "RP" modifier and the charge for the repairs and/or parts.

2. "XE" (Non-Medicare covered service) is used to indicate that a service provided to a Medicare/Medicaid beneficiary is not reimbursable by Medicare.

N.J. Admin. Code § 10:55-2.2

Amended by R.2000 d.134, effective 4/3/2000.
See: 31 New Jersey Register 3964(a), 32 New Jersey Register 1206(a).
In (c), substituted a reference to Medicaid and NJ KidCare fee-for-service programs for a reference to programs in the introductory paragraph, and substituted a reference to beneficiaries for a reference to providers in 2.
Amended by R.2004 d.406, effective 11/1/2004.
See: 35 New Jersey Register 4417(a), 36 New Jersey Register 4963(a).