New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 55 - PROSTHETIC AND ORTHOTIC SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:55-1.6 - Prescription policies

1. Prosthetic and orthotic appliances;

2. Repair and replacement of parts for custom-made prosthetic and orthotic appliances; and

3. Orthopedic footwear.

1. Beneficiary's name, age, address and Health Benefits Identification (HBID) Number;

2. Relevant diagnosis supporting need for custom-made prosthetic and orthotic appliances, including a statement of medical necessity signed by the physician or the advanced practice nurse providing the diagnosis;

3. A detailed breakdown of the appliance ordered, written according to the accepted New Jersey prosthetic and orthotic nomenclature as set forth in the accepted nomenclature by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Incorporated. A prescription written: "leg brace," "artificial limb" or "orthopedic shoes," for example, shall not be acceptable; and

4. If an individual other than a physician or advanced practice nurse completes the detailed description of the item, the treating physician or advanced practice nurse must review and personally sign and date the detailed description of the order to indicate agreement with the description. The physician's or advanced practice nurse's signature and date must be an original; the use of date and/or signature stamps is not acceptable.