N.J. Admin. Code § 10:62-1.14

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:62-1.14 - Home services

(a) The home visit HCPCS 99344 and 99353 shall not apply to residential health care facility or nursing facility settings. These HCPCS refer to a physician visit limited to the provision of medical care to an individual who would be too ill to go to a physician's office and/or is "home bound" due to his or her physical condition. When billing for a second or subsequent patient treated during the same visit, the visit shall be billed as a home visit.

(b) For purposes of New Jersey Medicaid/NJ FamilyCare fee-for-service reimbursement, HCPCS 99341, 99342, 99351, and 99352 apply when the provider visits a New Jersey Medicaid/NJ FamilyCare fee-for- service beneficiary in the home setting and the visit does not meet the criteria specified for a home visit in (a) above.

(c) In addition to the recordkeeping requirements indicated in N.J.A.C. 10:62-1.21, the record and documentation of a home visit shall become part of the office progress notes and shall include, as appropriate, the following information:

1. The purpose of the visit;

2. The pertinent history obtained;

3. Pertinent physical findings, including pertinent negative physical findings based on (c)1 and 2 above;

4. The procedures, if any performed, with results;

5. Lab, X-ray ECG, etc., ordered with results; and

6. A diagnosis(es) plus treatment plan status relative to present or pre-existing illness(es) plus pertinent recommendations and actions.

N.J. Admin. Code § 10:62-1.14

Amended by 49 N.J.R. 2279(b), effective 7/17/2017

Amended by 56 N.J.R. 2079(c), effective 10/21/2024