Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 54 - PHYSICIAN SERVICES
Subchapter 4 - BASIS OF PAYMENT
Section 10:54-4.16 - Multiple surgical procedures; same session

N.J. Admin. Code § 10:54-4.16

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Current through Register Vol. 56, No. 24, December 18, 2024
Section 10:54-4.16 - Multiple surgical procedures; same session
(a) Multiple surgical procedures during the same operative session shall be reimbursed as follows:
1. The primary surgical procedure shall be reimbursed at 100 percent of the Maximum Fee Allowance;
2. The secondary surgical procedure(s) shall be reimbursed at 50 percent of the Maximum Fee Allowance; and
3. The maximum reimbursement threshold for any operative procedure is 200 percent of the amount of the Maximum Fee Allowance of the primary surgical procedure.
(b) Incidental surgical procedures shall not be reimbursed in addition to any primary and/or secondary surgical procedure(s). A list of those procedure codes considered by the New Jersey Medicaid/NJ FamilyCare program to be incidental procedures is located in N.J.A.C. 10:54-9.11(b).

N.J. Admin. Code § 10:54-4.16

Recodified from N.J.A.C. 10:54-4.15 by R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 N.J.R. 1060(a).
Former N.J.A.C. 10:54-4.16, Repeat or revisitation of the surgical procedure, recodified to N.J.A.C. 10:54-4.17.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 N.J.R. 1060(a), 30 N.J.R. 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In (a)1 and (a)2, substituted "Maximum Fee Allowance" for "Medicaid Maximum Allowable Fee"; in (a)3, substituted "Allowance" for "Schedule"; and in (b), inserted "/NJ FamilyCare".