New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 52 - HOSPITAL SERVICES MANUAL
Subchapter 2 - POLICIES AND PROCEDURES RELATED TO SPECIFIC SERVICES
Section 10:52-2.14 - Hysterectomy
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The Division covers hysterectomy procedures performed on Medicaid/NJ FamilyCare fee-for-service beneficiaries based on Federal regulations ( 42 CFR 441.250 through 441.258 ) and related requirements outlined in this section and in the billing instructions. For hysterectomy requirements see (b) through (d) below. In addition, see N.J.A.C. 10:52-1.13for the requirements for a Second Surgical Opinion for performing a hysterectomy.
(b) "Hysterectomy" means an operation for the purpose of removing the uterus.
(c) Surgical hysterectomy procedures claim processing and reporting require the completion of the "Hysterectomy Receipt of Information Form (FD-189)" or, under certain conditions (see (d)1iii below), a physician certification. A second opinion shall be obtained and shall be submitted with the claim.
(d) The specific requirements to be met or documented on the "Hysterectomy Receipt of Information," (FD-189) form or, under certain conditions, a physician certification, shall be as follows:
(e) Any New Jersey hospital with electronic billing capabilities shall submit a "hard copy" of the UB-92 claim form for all hysterectomy claims with the FD-189 form attached to the claim form and must not submit the claim through the EMC claim processing system.