New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 5 - POLICIES AND PROCEDURES FOR PROVISION OF SERVICES PRESCRIBED OR RENDERED BY A PHYSICIAN
Section 10:54-5.6 - Diagnostic endoscopic procedures; with biopsy
Universal Citation: NJ Admin Code 10:54-5.6
Current through Register Vol. 56, No. 18, September 16, 2024
(a) For diagnostic endoscopic procedures with biopsies, the pricing logic for multiple surgical procedures applies (see 10:54-4.15) . In some instances, there is a specific CPT (HCPCS) code associated with that procedure which includes the biopsy and that HCPCS code must be used when requesting reimbursement.
(b) The modifier 22 shall be used with the HCPCS which designates the diagnostic endoscopic procedures with a biopsy when the code does not specifically designate a biopsy. The multiple procedure surgical pricing logic does apply to the reimbursement of these codes. (See also 10:54-9.5 under each specific code.)
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