N.J. Admin. Code § 10:54-4.6

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:54-4.6 - Use of HCPCS codes for home visits and house calls

(a) "House call" means a physician visit limited to the provision of medical care to an individual who is too ill to go to a physician's office and/or is "home bound" due to his or her physical condition.

(b) The house call codes do not distinguish between specialist and non-specialist reimbursement. House call codes apply when a detailed history, detailed examination and medical decision making of high complexity is provided.

(c) The home visit codes shall apply when the provider visits in the home setting and the visit does not meet the criteria specified in (a) and (b) above.

(d) When billing for a second or subsequent patient treated during the same visit, the visit shall be billed as a home visit, no matter what the complexity of care.

(e) House call and home visit codes shall not apply to visits to a residential health care facility or a nursing facility setting.

(f) In order to receive reimbursement for a house call or home visit, the documentation requirements set forth in N.J.A.C. 10:54-2.8 and 2.9 shall be met.

N.J. Admin. Code § 10:54-4.6

Recodified from N.J.A.C. 10:54-4.5 by R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 New Jersey Register 1060(a).
Former N.J.A.C. 10:54-4.6, Use of HCPCS codes for emergency department services, recodified to N.J.A.C. 10:54-4.7.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 New Jersey Register 1060(a), 30 New Jersey Register 3519(a).
Readopted the provisions of R.1998 d.154 without change.