N.J. Admin. Code § 10:54-4.8

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

Section 10:54-4.8 - Use of HCPCS codes for critical care services

(a) For critical care services to be covered by the Program, the HCPCS codes 99291 and 99292 shall be used and the service shall be consistent with the following requirement in order to be reimbursed:

1. The patient's situation requires constant physician attendance which is given by the physician to the exclusion of his or her other patients and duties and, therefore, for him or her, represents what is beyond usual service. This shall be verified by the applicable records, as defined by the setting. The records shall show, in the physician's handwriting, the time of onset and time of completion of the service.

(b) HCPCS codes 99291 and 99292 may be used in all settings, such as office, hospital, home, residential health care facility and nursing facility.

(c) HCPCS codes 99291 and 99292 shall not be used simultaneously with procedure codes that pay a reimbursement for the same time or type of service. (See N.J.A.C. 10:54-9.8 for procedure codes that must not be billed with Critical Care Service codes.)

N.J. Admin. Code § 10:54-4.8

Recodified from N.J.A.C. 10:54-4.7 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. 10:54-4.8, Use of HCPCS codes for neonatal intensive care, recodified to N.J.A.C. 10:54-4.9.
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.