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 10:54-9.4 - HCPCS procedure codes and maximum fee schedule for medicine
Universal Citation: NJ Admin Code 10:54-9.4
Current through Register Vol. 56, No. 18, September 16, 2024
| Maximum Fee | Anes | |||||
|---|---|---|---|---|---|---|
| HCPCS | Allowance | Basic | ||||
| IND | Code | Mod | S | $ | NS | Units |
| N | 99183 | 27.00 | NA | |||
| N | 99190 | 45.00 | NA | |||
| N | 99191 | 33.75 | NA | |||
| N | 99192 | 22.50 | NA | |||
| 99195 | 28.00 | 28.00 | ||||
| 99199 | BR | BR | ||||
| N | 99201 | 16.00 | 14.00 | |||
| N | 99202 | 16.00 | 14.00 | |||
| N | 99203 | 22.00 | 17.00 | |||
| N | 99204 | 22.00 | 17.00 | |||
| N | 99205 | 22.00 | 17.00 | |||
| E N | 99211 | 16.00 | 14.00 | |||
| 99211 | WM | NA | 11.20 | |||
| E N | 99212 | 16.00 | 14.00 | |||
| 99212 | WM | NA | 11.20 | |||
| E N | 99213 | 16.00 | 14.00 | |||
| 99213 | WM | NA | 11.20 | |||
| E N | 99214 | 16.00 | 14.00 | |||
| 99214 | WM | NA | 11.20 | |||
| E N | 99215 | 16.00 | 14.00 | |||
| E N | 99215 | WM | NA | 11.20 | ||
| N | 99217 | 16.00 | 14.00 | |||
| N | 99221 | 22.00 | 17.00 | |||
| N | 99222 | 22.00 | 17.00 | |||
| N | 99223 | 22.00 | 17.00 | |||
| N | 99231 | 16.00 | 14.00 | |||
| N | 99232 | 16.00 | 14.00 | |||
| N | 99233 | 16.00 | 14.00 | |||
| 99238 | 16.00 | 14.00 | ||||
| N | 99241 | 44.00 | NA | |||
| N | 99242 | 44.00 | NA | |||
| N | 99243 | 44.00 | NA | |||
| N | 99244 | 62.00 | NA | |||
| N | 99245 | 62.00 | NA | |||
| N | 99251 | 44.00 | NA | |||
| N | 99252 | 44.00 | NA | |||
| N | 99253 | 44.00 | NA | |||
| N | 99254 | 62.00 | NA | |||
| N | 99255 | 62.00 | NA | |||
| N | 99261 | 16.00 | 14.00 | |||
| N | 99262 | 16.00 | 14.00 | |||
| N | 99263 | 16.00 | 14.00 | |||
| N | 99271 | 44.00 | NA | |||
| N | 99272 | 44.00 | NA | |||
| N | 99273 | 44.00 | NA | |||
| N | 99274 | 62.00 | NA | |||
| N | 99274 | YY | 50.00 | NA | ||
| N | 99274 | ZZ | 50.00 | NA | ||
| N | 99275 | 62.00 | NA | |||
| N | 9928 | 19.00 | 7.00 | |||
| N | 99282 | 9.00 | 7.00 | |||
| N | 99283 | 9.00 | 7.00 | |||
| N | 99284 | 9.00 | 7.00 | |||
| N | 99285 | 9.00 | 7.00 | |||
| N | 99291 | 45.00 | 40.00 | |||
| N | 99292 | 22.50 | 20.00 | |||
| 99293 | 435.10 | 369.90 | ||||
| 99294 | 198.50 | 169.10 | ||||
| 99299 | 60.00 | 51.00 | ||||
| N | 99301 | 22.00 | 17.00 | |||
| N | 99302 | 22.00 | 17.00 | |||
| N | 99303 | 22.00 | 17.00 | |||
| E N | 99311 | 16.00 | 14.00 | |||
| E N | 99312 | 16.00 | 14.00 | |||
| E N | 99313 | 16.00 | 14.00 | |||
| N | 99321 | 22.00 | 17.00 | |||
| N | 99322 | 22.00 | 17.00 | |||
| N | 99323 | 22.00 | 17.00 | |||
| E N | 99331 | 16.00 | 14.00 | |||
| E N | 99332 | 16.00 | 14.00E | |||
| N | 99333 | 16.00 | 14.00 | |||
| N | 99341 | 16.00 | 14.00 | |||
| N | 99341 | WM | NA | 11.20 | ||
| N | 99342 | 16.00 | 14.00 | |||
| N | 99342 | WM | NA | 11.20 | ||
| N | 99343 | 35.00 | 35.00 | |||
| N | 99351 | 16.00 | 14.00 | |||
| N | 99351 | WM | NA | 11.20 | ||
| N | 99352 | 16.00 | 14.00 | |||
| N | 99352 | WM | NA | 11.20 | ||
| N | 99353 | 35.00 | 35.00 | |||
| N | 99354 | 45.00 | 40.00 | |||
| N | 99355 | 22.50 | 20.00 | |||
| N | 99356 | 45.00 | 40.00 | |||
| N | 99357 | 22.50 | 20.00 | |||
| N | 99382 | 22.00 | 17.00 | |||
| N | 99383 | 22.00 | 17.00 | |||
| N | 99384 | 22.00 | 17.00 | |||
| N | 99385 | 22.00 | 17.00 | |||
| N | 99386 | 22.00 | 17.00 | |||
| N | 99387 | 22.00 | 17.00 | |||
| N | 99391 | 16.00 | 14.00 | |||
| N | 99392 | 22.00 | 17.00 | |||
| N | 99393 | 22.00 | 17.00 | |||
| N | 99394 | 22.00 | 17.00 | |||
| N | 99395 | 22.00 | 17.00 | |||
| N | 99396 | 22.00 | 17.00 | |||
| N | 99397 | 22.00 | 17.00 | |||
| N | 99431 | 27.00 | 23.00 | |||
| 99499 | BR | BR | ||||
| 99600 | BR | BR | ||||
| L | H5025 | 8.00 | 6.00 | |||
| N | J0690 | 1.92 | 1.92 | |||
| N | J0696 | 10.24 | 10.24 | |||
| N | J1100 | 0.80 | 0.80 | |||
| N | J1200 | 0.55 | 0.55 | |||
| N | J2550 | 0.42 | 0.42 | |||
| N | J2680 | 9.50 | 9.50 | |||
| N | J2790 | 20.40 | 20.40 | |||
| N | J2790 | 22 | 72.07 | 72.07 | ||
| J3395 | Average Wholesale Price (AWP) | |||||
| N | J9000 | 42.00 | 42.00 | |||
| N | J9010 | 195.50 | 195.50 | |||
| N | J9020 | 50.36 | 50.36 | |||
| N | J9031 | 152.13 | 152.13 | |||
| N | J9040 | 255.08 | 255.08 | |||
| N | J9045 | 72.01 | 72.01 | |||
| N | J9060 | 30.33 | 30.33 | |||
| N | J9070 | 4.91 | 4.91 | |||
| N | J9100 | 6.72 | 6.72 | |||
| N | J9130 | 12.00 | 12.00 | |||
| N | J9190 | 0.18 | 0.18 | |||
| N | J9217 | 451.25 | 451.25 | |||
| N | J9230 | 10.10 | 10.10 | |||
| N | J9240 | 9.05 | 9.05 | |||
| N | J9240 | 22 | 31.50 | 31.50 | ||
| N | J9260 | 4.75 | 4.75 | |||
| N | J9280 | 119.08 | 119.08 | |||
| N | J9360 | 3.25 | 3.25 | |||
| N | J9370 | 27.50 | 27.50 | |||
| L | W9025 | 72.00 | 69.00 | |||
| L | W9025 | WM | NA | 67.00 | ||
| L | W9026 | 22.00 | 21.00 | |||
| L | W9026 | WM | NA | 19.00 | ||
| L | W9027 | 465.00 | 418.00 | |||
| L | W9027 | WM | 371.00 | |||
| L | W9028 | 22.00 | 21.00 | |||
| L | W9028 | WM | 19.00 | |||
| L | W9029 | 487.00 | 439.00 | |||
| L | W9029 | WM | 390.00 | |||
| L | W9030 | 867.00 | 802.00 | |||
| L | W9030 | WM | 723.00 | |||
| L | W9031 | 595.00 | 531.00 | |||
| L | W9040 | 30.00 | 30.00 | |||
| L | W9041 | 120.00 | 120.00 | |||
| L | W9042 | 50.00 | 50.00 | |||
| L | W9043 | 100.00 | 100.00 | |||
| L | W9050 | 27.00 | 27.00 | |||
| L | W9055 | 27.00 | 27.00 | |||
| L | W9060 | 31.00 | 26.00 | |||
| L | W9060 | WT | 23.00 | 18.00 | ||
| L | W9061 | 31.00 | 26.00 | |||
| L | W9061 | WT | 23.00 | 18.00 | ||
| L | W9062 | 31.00 | 26.00 | |||
| L | W9062 | WT | 23.00 | 18.00 | ||
| L | W9063 | 31.00 | 26.00 | |||
| L | W9063 | WT | 23.00 | 18.00 | ||
| L | W9064 | 31.00 | 26.00 | |||
| L | W9064 | WT | 23.00 | 18.00 | ||
| L | W9065 | 31.00 | 26.00 | |||
| L | W9065 | WT | 23.00 | 18.00 | ||
| L | W9066 | 31.00 | 26.00 | |||
| L | W9066 | WT | 23.00 | 18.00 | ||
| L | W9067 | 31.00 | 26.00 | |||
| L | W9067 | WT | 23.00 | 18.00 | ||
| L | W9068 | 31.00 | 26.00 | |||
| L | W9068 | WT | 23.00 | 18.00 | ||
| L | W9095 | 6.60 | 6.60 | |||
| L | W9096 | 17.46 | 17.46 | |||
| L | W9096 | 22 | 32.79 | 32.79 | ||
| L | W9096 | 52 | 2.50 | 2.50 | ||
| L | W9097 | 17.46 | 17.46 | |||
| L | W9097 | 52 | 2.50 | 2.50 | ||
| L | W9098 | 32.79 | 32.79 | |||
| L | W9098 | 52 | 2.50 | 2.50 | ||
| L | W9099 | 63.57 | 63.57 | |||
| L | W9099 | 52 | 2.50 | 2.50 | ||
| L | W9170 | 13.00 | 13.00 | |||
| L | W9200 | 12.00 | NA | |||
| L | W9205 | 70.00 | NA | |||
| L | W9210 | 70.00 | NA | |||
| L | W9215 | 9.00 | NA | |||
| L | W9220 | 16.00 | NA | |||
| L | W9310 | 51.00 | NA | |||
| L | W9333 | 27.88 | 27.88 | |||
| L | W9333 | 52 | 2.50 | 2.50 | ||
| L | W9334 | 27.88 | 27.88 | |||
| L | W9334 | 52 | 2.50 | 2.50 | ||
| L | W9335 | 62.09 | 62.09 | |||
| L | W9335 | 52 | 2.50 | 2.50 | ||
| L | W9336 | 36.90 | 36.90 | |||
| L | W9337 | 2.34 | 2.34 | |||
| L | W9338 | 30.27 | 30.27 | |||
| L | W9339 | 360.63 | 360.63 | |||
| L | W9343 | 451.25 | 451.25 | |||
| L | W9344 | 811.25 | 811.25 | |||
| L | W9345 | 902.50 | 902.50 | |||
| L | W9378 | 16.00 | NA | |||
| L | W9382 | 16.00 | NA | |||
| L | W9384 | 16.00 | NA | |||
| L | W9385 | 16.00 | NA | |||
| L | W9386 | 16.00 | NA | |||
| L | W9387 | 16.00 | NA | |||
| L | W9388 | 16.00 | NA | |||
| L | W9450 | 100.00 | NA | |||
| L | W9450 | 2633.00 | NA | |||
| L | W9820 | 23.00 | 18.00 | |||
| L | W9840 | 150.00 | 150.00 | |||
| L | W9847 | 63.00 | NA | |||
| L | W9848 | 28.00 | 30.00 | |||
| L | W9849 | 28.00 | 30.00 | |||
| L | Z0250 | WM | NA | 40.00 | ||
| L | Z0300 | 7.00 | 7.00 | |||
| L | Z0310 | 45.00 | 45.00 | |||
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