New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 55 - PROSTHETIC AND ORTHOTIC SERVICES
Subchapter 2 - CENTERS FOR MEDICARE AND MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM HCPCS
Section 10:55-2.2 - Elements of HCPCS Coding System

Universal Citation: NJ Admin Code 10:55-2.2

Current through Register Vol. 56, No. 18, September 16, 2024

(a) The list of HCPCS procedure codes in 10:55-2.3 and 2.4 is arranged in tabular form with specific information for each code given under columns with the titles "HCPCS Code," "Description," and "Maximum Fee Allowance."

(b) The column titled "MAXIMUM FEE ALLOWANCE" indicates the maximum amount of reimbursement or the following symbol:

1. Where "B.R." (By Report) is listed instead of a dollar amount, it means that additional information will be required in order to properly evaluate the service. In such instances, the provider shall attach a copy of the report to the claim form.

(c) Services and procedures may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of alphabetic and/or numeric characters at the end of the HCPCS procedure code. The New Jersey Medicaid NJ FamilyCare fee-for-service program's recognized modifier codes for prosthetic and orthotic services are as follows:

1. "RP" (Repair and/or Replacement) is used to indicate repair and/or replacement of prosthetic and orthotic devices. The claim shows the HCPCS procedure code for the repairs and/or parts, followed by the "RP" modifier and the charge for the repairs and/or parts.

2. "XE" (Non-Medicare covered service) is used to indicate that a service provided to a Medicare/Medicaid beneficiary is not reimbursable by Medicare.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.