New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 9 - HEALTH CARE FINANCING ADMINISTRATION (HCFA) COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:54-9.2 - Elements of HCPCS procedure codes which require attention

1. ALPHABETIC AND NUMERIC SYMBOLS UNDER "IND" & "MOD": These symbols when listed under the "IND" and "MOD" columns are elements of the HCPCS coding system used as qualifiers or indicators (as in the "IND" column) and as modifiers (as in the "MOD" column). They assist the physician or practitioner in determining the appropriate procedure codes to be used, the area to be covered, the minimum requirements needed, and any additional parameters required for reimbursement purposes.

1. When filing a claim, the appropriate HCPCS Codes must be used in conjunction with modifiers, when applicable.

2. The use of a procedure code will be interpreted by the New Jersey Medicaid program as evidence that the physician or practitioner personally furnished, as a minimum, the service for which it stands.

3. For purposes of reimbursement, a physician, practitioner, physicians' group, shared health care facility or physicians sharing a common record are considered a single provider.

4. When billing, the provider must enter a CPT/HCPCS code into the procedure code column field 24-D of the CMS 1500 claim form.

5. Date(s) of service(s) must be indicated on the claim form and in the physician's own record for each service billed.

6. When submitting a claim, the physician or practitioner must always use his/her usual and customary fee. The fees designated for the HCPCS procedure codes represent the New Jersey Medicaid program's maximum payment for the given procedure.

7. All references to time parameters shall mean the physician's or practitioner's personal time in reference to the service rendered unless it is otherwise indicated.

8. Certain listed procedures are commonly carried out as an integral part of a total service, and, as such, do not warrant a separate charge. Concerning the terminology "separate procedures" when attached to a HCPCS/CPT description, when a procedure is carried out as a separate entity not immediately related to other services, the indicated value for "separate procedure" is applicable.

9. Additional charges on a fee-for-service basis may be reimbursed for complications or other circumstances requiring additional or unusual services concurrent with the procedure(s) or during the listed period of normal follow-up care with a "22" modifier, if so designated with additional documentation accompanying to the claim form.