New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 6 - HEALTHSTART-MATERNITY AND PEDIATRIC CARE SERVICES
Section 10:54-6.19 - HealthStart maternity care code requirements
Universal Citation: NJ Admin Code 10:54-6.19
Current through Register Vol. 56, No. 18, September 16, 2024
(a) HealthStart Maternity Care code requirements are as follows:
1. Separate reimbursement shall be available for Maternity Medical Care Services and Maternity Health Support Services;
2. Maternity Medical Care Services shall be billed as a total obstetrical package, when feasible, but may be billed as separate procedures;
3. The enhanced reimbursement for the delivery and postpartum care may be claimed only for a patient who had received at least one antepartum HealthStart Maternity Medical or Health Support Service;
4. The modifier "WM" in the HCPCS list of procedure codes refers to those services provided by certified nurse midwives who shall include the modifier at the end of each code; and
5. Laboratory and other diagnostic procedures and all necessary medical consultations shall be eligible for separate reimbursement.
(b) HealthStart Maternity Medical Care procedure codes are provided in 10:54-9.10(k) and (l), Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System (HCPCS).
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