New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 57 - PODIATRY SERVICES
Subchapter 3 - CENTERS FOR MEDICARE AND MEDICAID SERVICES CMS HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:57-3.2 - HCPCS procedure codes and maximum fee allowance
Universal Citation: NJ Admin Code 10:57-3.2
Current through Register Vol. 56, No. 6, March 18, 2024
(a) MEDICINE
| IND | HCPCS Code | Mod | Maximum Fee Allowance S | $ | NS | Anes Basic Units |
| 90703 | 17.72 | 3.40 | ||||
| 93922 | 22.00 | 21.00 | ||||
| 93922 | 26 | 9.00 | 8.00 | |||
| 93922 | TC | 13.00 | 13.00 | |||
| 93923 | 45.00 | 42.00 | ||||
| 93923 | 26 | 18.10 | 15.10 | |||
| 93923 | TC | 26.90 | 22.00 | |||
| 93965 | 30.00 | 28.00 | ||||
| 93965 | 26 | 12.00 | 10.00 | |||
| 93965 | TC | 18.00 | 18.00 | |||
| 93970 | 62.00 | 58.00 | ||||
| 93970 | 26 | 24.00 | 20.00 | |||
| 93970 | TC | 38.00 | 38.00 | |||
| 93971 | 30.00 | 28.00 | ||||
| 93971 | 26 | 12.00 | 10.00 | |||
| 93971 | TC | NA | 18.00 | |||
| 96360 | 20.22 | 17.19 | ||||
| 96361 | 7.12 | 6.05 | ||||
| 96365 | 38.35 | 32.60 | ||||
| 96366 | 11.39 | 9.68 | ||||
| 96367 | 16.53 | 14.05 | ||||
| 96368 | 11.03 | 9.37 | ||||
| 96369 | 89.74 | 76.28 | ||||
| 96370 | 8.13 | 6.91 | ||||
| 96371 | 35.38 | 30.97 | ||||
| 96372 | 8.72 | 7.41 | ||||
| 96373 | 9.87 | 8.39 | ||||
| 96374 | 20.78 | 17.66 | ||||
| 96375 | 8.84 | 7.51 | ||||
| 96376 | 14.14 | 12.01 | ||||
| 96379 | 2.50 | 2.50 | ||||
| 99025 | 22.00 | 17.00 | ||||
| 99199 | B.R. | B.R. | ||||
| N | 99201 | 24.78 | 21.06 | |||
| N | 99202 | 41.08 | 34.92 | |||
| N | 99203 | 58.02 | 49.31 | |||
| N | 99204 | 87.59 | 74.45 | |||
| N | 99205 | 109.89 | 93.40 | |||
| N | 99211 | 16.00 | 14.00 | |||
| N | 99212 | 24.41 | 20.22 | |||
| N | 99213 | 39.85 | 33.87 | |||
| N | 99214 | 58.21 | 49.48 | |||
| N | 99215 | 77.76 | 66.10 | |||
| N | 99217 | 38.64 | 32.84 | |||
| N | 99221 | 53.17 | 45.19 | |||
| N | 99222 | 71.88 | 61.10 | |||
| N | 99223 | 106.24 | 90.30 | |||
| N | 99231 | 23.50 | 20.60 | |||
| N | 99232 | 38.20 | 32.47 | |||
| N | 99233 | 54.59 | 46.40 | |||
| N | 99234 | 69.80 | 59.33 | |||
| N | 99235 | 88.90 | 75.56 | |||
| N | 99236 | 114.23 | 97.10 | |||
| 99238 | 38.64 | 32.84 | ||||
| N | 99239 | 56.64 | 48.14 | |||
| N | 99241 | 44.00 | 37.00 | |||
| N | 99242 | 64.70 | 54.40 | |||
| N | 99243 | 64.70 | 54.40 | |||
| N | 99244 | 91.10 | 77.90 | |||
| N | 99245 | 91.10 | 77.90 | |||
| N | 99251 | 34.50 | 29.30 | |||
| N | 99252 | 64.70 | 54.40 | |||
| N | 99253 | 64.70 | 54.40 | |||
| N | 99254 | 91.10 | 77.90 | |||
| N | 99255 | 91.10 | 77.90 | |||
| N | 99261 | 16.00 | 14.00 | |||
| 99262 | 23.50 | 20.60 | ||||
| 99263 | 23.50 | 20.60 | ||||
| 99281 | 16.00 | 14.00 | ||||
| 99282 | 23.50 | 20.60 | ||||
| 99283 | 32.23 | 27.40 | ||||
| 99284 | 61.11 | 51.94 | ||||
| 99285 | 89.92 | 76.43 | ||||
| N | 99304 | 45.67 | 38.82 | |||
| N | 99305 | 66.07 | 56.16 | |||
| N | 99306 | 84.57 | 71.88 | |||
| N | 99307 | 22.39 | 19.03 | |||
| N | 99308 | 35.08 | 29.81 | |||
| N | 99309 | 46.62 | 39.63 | |||
| N | 99310 | 68.95 | 58.60 | |||
| N | 99315 | 38.83 | 33.01 | |||
| N | 99316 | 55.80 | 47.43 | |||
| N | 99318 | 48.66 | 41.36 | |||
| N | 99324 | 28.06 | 23.85 | |||
| N | 99325 | 40.56 | 34.47 | |||
| N | 99326 | 70.36 | 59.81 | |||
| N | 99334 | 30.65 | 26.05 | |||
| N | 99335 | 48.26 | 41.02 | |||
| N | 99336 | 68.73 | 58.42 | |||
| N | 99341 | 29.18 | 24.81 | |||
| N | 99342 | 41.94 | 35.65 | |||
| N | 99343 | 63.82 | 58.07 | |||
| 99344 | 96.05 | 81.64 | ||||
| 99345 | 116.83 | 99.30 | ||||
| N | 99347 | 35.00 | 35.00 | |||
| 99348 | 51.50 | 51.50 | ||||
| 99349 | 68.14 | 57.92 | ||||
| 99350 | 94.43 | 80.26 | ||||
| N | 99499 | B.R. | B.R. | |||
| N | 99600 | B.R. | B.R. |
(b) SURGERY
| IND | HCPCS Code | Mod | Follow Up Days | Maximum Fee Allowance S | $ | NS | Anes Basic Units |
| 10021 | 0 | 49.00 | 45.00 | 3 | |||
| 10021 | TC | 0 | 19.00 | 19.00 | 0 | ||
| 10021 | 26 | 0 | 30.00 | 26.00 | 0 | ||
| 10022 | 0 | 87.00 | 78.00 | 3 | |||
| 10022 | TC | 0 | 26.00 | 26.00 | 0 | ||
| 10022 | 26 | 0 | 61.00 | 52.00 | 0 | ||
| 10060 | 0 | 13.00 | 11.00 | 3 | |||
| 10061 | 10 | 48.00 | 42.00 | 3 | |||
| 10120 | 0 | 18.00 | 16.00 | 3 | |||
| 10121 | 30 | 34.00 | 29.00 | 3 | |||
| 10140 | 0 | 18.00 | 16.00 | 3 | |||
| 10160 | 0 | 13.00 | 11.00 | 3 | |||
| 10180 | 14 | 100.00 | 85.00 | 3 | |||
| 11000 | 0 | 13.00 | 11.00 | 3 | |||
| 11001 | 0 | 6.00 | 5.00 | 3 | |||
| 11040 | 0 | 13.00 | 11.00 | 3 | |||
| 11041 | 0 | 13.00 | 11.00 | 3 | |||
| 11042 | 0 | 16.00 | 14.00 | 3 | |||
| 11043 | 0 | 23.93 | 20.34 | 3 | |||
| 11044 | 0 | 48.00 | 42.00 | 3 | |||
| 11055 | 0 | 13.00 | 11.00 | 3 | |||
| 11056 | 0 | 18.00 | 15.00 | 3 | |||
| 11057 | 0 | 23.00 | 20.00 | 3 | |||
| 11100 | 7 | 13.00 | 11.00 | 3 | |||
| 11101 | 0 | 5.00 | 4.00 | 3 | |||
| 11300 | 0 | 18.00 | 16.00 | 3 | |||
| 11301 | 0 | 22.00 | 20.00 | 3 | |||
| 11302 | 0 | 27.00 | 24.00 | 3 | |||
| 11303 | 0 | 32.00 | 27.00 | 3 | |||
| 11305 | 0 | 18.00 | 16.00 | 3 | |||
| 11306 | 0 | 22.00 | 20.00 | 3 | |||
| 11307 | 0 | 27.00 | 24.00 | 3 | |||
| 11308 | 0 | 32.00 | 27.00 | 3 | |||
| 11400 | 15 | 18.00 | 16.00 | 3 | |||
| 11401 | 15 | 22.00 | 20.00 | 3 | |||
| 11402 | 15 | 27.00 | 24.00 | 3 | |||
| 11403 | 15 | 32.00 | 27.00 | 3 | |||
| 11404 | 15 | 32.00 | 27.00 | 3 | |||
| 11406 | 15 | 32.00 | 27.00 | 3 | |||
| 11420 | 15 | 18.00 | 16.00 | 3 | |||
| 11421 | 15 | 22.00 | 20.00 | 3 | |||
| 11422 | 15 | 27.00 | 24.00 | 3 | |||
| 11423 | 15 | 32.00 | 27.00 | 3 | |||
| 11424 | 15 | 32.00 | 27.00 | 3 | |||
| 11426 | 15 | 32.00 | 27.00 | 3 | |||
| 11470 | 15 | 91.00 | 78.00 | 5 | |||
| 11600 | 90 | 37.00 | 32.00 | 3 | |||
| 11601 | 90 | 47.00 | 42.00 | 3 | |||
| 11602 | 90 | 61.00 | 53.00 | 3 | |||
| 11604 | 90 | 80.00 | 70.00 | 3 | |||
| 11606 | 90 | 92.00 | 80.00 | 3 | |||
| 11620 | 90 | 61.00 | 53.00 | 3 | |||
| 11621 | 90 | 90.00 | 79.00 | 3 | |||
| 11622 | 90 | 121.00 | 105.00 | 3 | |||
| 11623 | 90 | 140.00 | 121.00 | 3 | |||
| 11624 | 90 | 162.00 | 139.00 | 3 | |||
| 11626 | 90 | 186.00 | 160.00 | 3 | |||
| 11719 | 0 | 5.00 | 5.00 | 3 | |||
| 11720 | 0 | 13.00 | 11.00 | 3 | |||
| E | 11721 | 0 | 21.00 | 18.00 | 3 | ||
| 11730 | 0 | 11.58 | 9.84 | 3 | |||
| 11732 | 0 | 3.91 | 3.32 | 3 | |||
| 11740 | 0 | 16.00 | 14.00 | 3 | |||
| 11750 | 30 | 42.00 | 37.00 | 3 | |||
| 11752 | 30 | 59.00 | 50.00 | 3 | |||
| 11755 | 0 | 25.00 | 20.00 | 3 | |||
| 11760 | 60 | 42.00 | 37.00 | 3 | |||
| 11762 | 90 | 69.00 | 59.00 | 3 | |||
| 11765 | 60 | 21.00 | 18.00 | 3 | |||
| 11900 | 0 | 16.00 | 14.00 | 3 | |||
| 11901 | 0 | 16.00 | 14.00 | 3 | |||
| 11981 | 0 | 100.00 | 85.00 | 3 | |||
| 11982 | 0 | 100.00 | 85.00 | 3 | |||
| 11983 | 0 | 180.00 | 153.00 | 3 | |||
| 12001 | 0 | 18.00 | 16.00 | 3 | |||
| 12002 | 0 | 24.00 | 21.00 | 3 | |||
| 12004 | 0 | 30.00 | 26.00 | 3 | |||
| 12005 | 7 | 46.00 | 39.00 | 3 | |||
| 12006 | 7 | 57.00 | 48.00 | 3 | |||
| 12007 | 7 | 82.50 | 70.00 | 3 | |||
| 12020 | 7 | 57.00 | 48.00 | 5 | |||
| 12021 | 7 | 57.00 | 48.00 | 5 | |||
| 12041 | 30 | 30.00 | 26.00 | 3 | |||
| 12042 | 30 | 67.00 | 59.00 | 4 | |||
| 12044 | 30 | 82.50 | 70.00 | 4 | |||
| 12045 | 30 | 99.00 | 84.00 | 4 | |||
| 12046 | 30 | 110.00 | 94.00 | 4 | |||
| 12047 | 30 | 143.00 | 120.00 | 4 | |||
| 13131 | 30 | 67.00 | 59.00 | 4 | |||
| 13132 | 30 | 145.00 | 126.00 | 4 | |||
| 13160 | 30 | 121.00 | 103.00 | 3 | |||
| 13300 | 30 | 242.00 | 210.00 | 4 | |||
| 14040 | 60 | 193.00 | 168.00 | 4 | |||
| 14041 | 60 | 242.00 | 210.00 | 4 | |||
| 14300 | 60 | 242.00 | 210.00 | 4 | |||
| 14350 | 60 | 193.00 | 168.00 | 3 | |||
| 15000 | 10 | 70.50 | 60.00 | 3 | |||
| 15001 | 0 | 40.00 | 34.00 | 0 | |||
| 15050 | 30 | 62.87 | 53.44 | 4 | |||
| 15100 | 45 | 121.00 | 105.00 | 3 | |||
| 15101 | 45 | 61.00 | 53.00 | 4 | |||
| 15120 | 45 | 182.00 | 158.00 | 4 | |||
| 15121 | 45 | 61.00 | 53.00 | 4 | |||
| 15220 | 45 | 151.00 | 131.00 | 4 | |||
| 15221 | 30 | 76.00 | 65.00 | 3 | |||
| 15240 | 45 | 151.00 | 131.00 | 4 | |||
| 15241 | 30 | 76.00 | 65.00 | 3 | |||
| 15342 | 0 | 36.00 | 31.00 | 0 | |||
| + | 15343 | 0 | 12.00 | 10.00 | 0 | ||
| 15350 | 45 | 68.00 | 54.00 | 3 | |||
| 15351 | 0 | 54.00 | 46.00 | 0 | |||
| 15400 | 45 | 68.00 | 54.00 | 3 | |||
| 15401 | 0 | 50.00 | 43.00 | 0 | |||
| 15572 | 45 | 217.00 | 185.00 | 3 | |||
| 15574 | 45 | 217.00 | 185.00 | 5 | |||
| 15610 | 45 | 89.00 | 77.00 | 4 | |||
| 15620 | 45 | 121.00 | 105.00 | 4 | |||
| 15850 | 0 | 35.00 | 35.00 | 3 | |||
| 15851 | 0 | 35.00 | 35.00 | 3 | |||
| 15852 | 0 | 35.00 | 35.00 | 3 | |||
| 16000 | 0 | 16.00 | 14.00 | 5 | |||
| 16010 | 0 | 35.00 | 35.00 | 3 | |||
| 16015 | 0 | 100.00 | 85.00 | 3 | |||
| 16020 | 0 | 16.00 | 14.00 | 0 | |||
| 16025 | 0 | 24.00 | 20.00 | 0 | |||
| 16030 | 0 | 32.00 | 27.00 | 0 | |||
| 16035 | 0 | 21.07 | 17.91 | 3 | |||
| + | 16036 | 0 | 40.00 | 34.00 | 0 | ||
| 17000 | 0 | 16.00 | 14.00 | 3 | |||
| 17003 | 0 | 5.00 | 4.00 | 3 | |||
| 17004 | 0 | 52.00 | 46.00 | 3 | |||
| 17106 | 0 | 111.75 | 95.00 | 3 | |||
| 17107 | 0 | 212.80 | 180.90 | 3 | |||
| 17108 | 0 | 322.85 | 274.40 | 3 | |||
| 17110 | 0 | 16.00 | 14.00 | 3 | |||
| 17111 | 0 | 23.00 | 20.00 | 3 | |||
| 17250 | 0 | 16.00 | 14.00 | 3 | |||
| 17270 | 15 | 29.20 | 24.81 | 3 | |||
| 17271 | 15 | 43.74 | 37.20 | 3 | |||
| 17272 | 15 | 52.20 | 44.36 | 3 | |||
| 17273 | 15 | 61.48 | 52.26 | 3 | |||
| 17274 | 15 | 76.81 | 65.30 | 3 | |||
| 17276 | 15 | 94.27 | 80.15 | 3 | |||
| 17304 | 0 | 100.00 | 85.00 | 3 | |||
| 17305 | 0 | 25.00 | 21.00 | 3 | |||
| 17306 | 0 | 25.00 | 21.00 | 3 | |||
| 17307 | 0 | 25.00 | 21.00 | 3 | |||
| 17310 | 0 | 15.00 | 13.00 | 3 | |||
| 17340 | 0 | 18.00 | 15.00 | 3 | |||
| 20000 | 0 | 18.00 | 16.00 | 3 | |||
| 20005 | 0 | 45.00 | 40.00 | 4 | |||
| 20206 | 0 | 29.00 | 25.00 | 3 | |||
| 20520 | 7 | 51.00 | 45.00 | 3 | |||
| 20525 | 7 | 102.00 | 90.00 | 4 | |||
| D | 20550 | 0 | 13.00 | 11.00 | 5 | ||
| E | 20551 | 0 | 13.00 | 11.00 | 3 | ||
| E | 20552 | 0 | 13.00 | 11.00 | 3 | ||
| E | 20553 | 0 | 13.00 | 11.00 | 3 | ||
| D | 20600 | 0 | 13.00 | 11.00 | 3 | ||
| D | 20605 | 0 | 13.00 | 11.00 | 3 | ||
| 20615 | 0 | 80.00 | 68.00 | 3 | |||
| 20650 | 0 | 55.00 | 47.00 | 4 | |||
| 20670 | 0 | 42.82 | 36.40 | 3 | |||
| 20680 | 21 | 121.00 | 105.00 | 4 | |||
| 20690 | 0 | 65.48 | 55.66 | 5 | |||
| 20692 | 21 | 211.75 | 180.00 | 3 | |||
| 20693 | 21 | 136.15 | 115.00 | 3 | |||
| 20694 | 21 | 60.50 | 51.00 | 3 | |||
| 20838 | 90 | 400.00 | 340.00 | 4 | |||
| 20900 | 30 | 113.00 | 96.00 | 3 | |||
| 20957 | 60 | 616.00 | 524.00 | 6 | |||
| 27530 | 30 | 74.00 | 65.00 | 3 | |||
| 27532 | 90 | 121.00 | 105.00 | 3 | |||
| 27535 | 90 | 242.00 | 210.00 | 3 | |||
| 27536 | 90 | 242.00 | 210.00 | 3 | |||
| 27603 | 30 | 114.00 | 97.00 | 3 | |||
| 27604 | 0 | 54.65 | 46.45 | 3 | |||
| 27605 | 15 | 38.34 | 32.59 | ||||
| 27606 | 30 | 63.00 | 54.00 | 3 | |||
| 27607 | 30 | 228.00 | 194.00 | 3 | |||
| 27610 | 60 | 182.00 | 158.00 | 3 | |||
| 27612 | 30 | 182.00 | 158.00 | 3 | |||
| 27613 | 0 | 28.18 | 23.95 | 3 | |||
| 27614 | 0 | 64.45 | 54.78 | 3 | |||
| 27615 | 60 | 228.00 | 194.00 | 3 | |||
| 27618 | 0 | 50.28 | 42.74 | 3 | |||
| 27619 | 30 | 57.00 | 49.00 | 3 | |||
| 27620 | 60 | 182.00 | 158.00 | 3 | |||
| 27625 | 90 | 211.00 | 184.00 | 3 | |||
| 27626 | 60 | 228.00 | 194.00 | 3 | |||
| 27630 | 30 | 90.00 | 79.00 | 3 | |||
| 27635 | 60 | 228.00 | 194.00 | 4 | |||
| 27637 | 60 | 285.00 | 243.00 | 4 | |||
| 27638 | 60 | 285.00 | 243.00 | 4 | |||
| 27640 | 60 | 211.00 | 184.00 | 4 | |||
| 27641 | 60 | 211.00 | 184.00 | 4 | |||
| 27645 | 90 | 342.00 | 291.00 | 4 | |||
| 27646 | 90 | 342.00 | 291.00 | 4 | |||
| 27647 | 90 | 371.00 | 316.00 | 4 | |||
| 27648 | 0 | 18.00 | 16.00 | 3 | |||
| 27650 | 90 | 227.00 | 197.00 | 4 | |||
| 27652 | 90 | 314.00 | 267.00 | 4 | |||
| 27654 | 90 | 314.00 | 267.00 | 4 | |||
| 27656 | 90 | 911.18 | 774.50 | 3 | |||
| 27658 | 90 | 121.00 | 105.00 | 3 | |||
| 27659 | 90 | 121.00 | 105.00 | 3 | |||
| 27664 | 90 | 90.00 | 79.00 | 3 | |||
| 27665 | 90 | 90.00 | 79.00 | 3 | |||
| 27675 | 30 | 171.00 | 146.00 | 3 | |||
| 27676 | 30 | 200.00 | 170.00 | 3 | |||
| 27680 | 30 | 143.00 | 122.00 | 3 | |||
| 27681 | 30 | 171.00 | 146.00 | 3 | |||
| 27685 | 90 | 151.00 | 131.00 | 4 | |||
| 27686 | 90 | 202.00 | 175.00 | 3 | |||
| 27687 | 30 | 171.00 | 146.00 | 3 | |||
| 27690 | 90 | 182.00 | 158.00 | 3 | |||
| 27691 | 90 | 342.00 | 291.00 | 3 | |||
| E | 27692 | 30 | 29.00 | 25.00 | 3 | ||
| 27695 | 90 | 302.00 | 263.00 | 3 | |||
| 27696 | 90 | 342.00 | 291.00 | 3 | |||
| 27698 | 90 | 227.00 | 197.00 | 3 | |||
| 27700 | 90 | 249.00 | 216.00 | 3 | |||
| 27705 | 90 | 272.00 | 236.00 | 3 | |||
| 27707 | 90 | 113.00 | 100.00 | 3 | |||
| 27709 | 90 | 350.00 | 298.00 | 3 | |||
| 27712 | 90 | 288.00 | 251.00 | 3 | |||
| 27715 | 90 | 570.00 | 485.00 | 4 | |||
| 27720 | 90 | 399.00 | 340.00 | 3 | |||
| 27722 | 90 | 428.00 | 364.00 | 3 | |||
| 27725 | 90 | 570.00 | 485.00 | 4 | |||
| 27727 | 90 | 570.00 | 485.00 | 4 | |||
| 27730 | 90 | 257.00 | 219.00 | 3 | |||
| 27732 | 30 | 143.00 | 122.00 | 3 | |||
| 27734 | 90 | 314.00 | 267.00 | 3 | |||
| 27740 | 90 | 302.00 | 263.00 | 3 | |||
| 27742 | 90 | 439.00 | 382.00 | 3 | |||
| 27745 | 60 | 200.00 | 170.00 | 3 | |||
| 27750 | 30 | 114.00 | 97.00 | 3 | |||
| 27752 | 90 | 121.00 | 105.00 | 3 | |||
| 27756 | 90 | 211.00 | 184.00 | 3 | |||
| 27758 | 90 | 314.00 | 267.00 | 3 | |||
| 27760 | 90 | 79.00 | 68.00 | 3 | |||
| 27762 | 90 | 79.00 | 68.00 | 3 | |||
| 27766 | 90 | 151.00 | 131.00 | 3 | |||
| 27780 | 7 | 45.00 | 39.00 | 3 | |||
| 27781 | 30 | 45.00 | 39.00 | 3 | |||
| 27784 | 90 | 121.00 | 105.00 | 3 | |||
| 27786 | 90 | 72.00 | 63.00 | 3 | |||
| 27788 | 90 | 79.00 | 68.00 | 3 | |||
| 27792 | 90 | 151.00 | 131.00 | 3 | |||
| 27808 | 30 | 100.00 | 85.00 | 3 | |||
| 27810 | 90 | 121.00 | 105.00 | 3 | |||
| 27814 | 90 | 211.00 | 184.00 | 3 | |||
| 27816 | 30 | 100.00 | 85.00 | 3 | |||
| 27818 | 90 | 121.00 | 105.00 | 3 | |||
| 27822 | 90 | 242.00 | 210.00 | 3 | |||
| 27823 | 90 | 242.00 | 210.00 | 3 | |||
| 27824 | 30 | 100.00 | 85.00 | 3 | |||
| 27825 | 90 | 121.00 | 105.00 | 3 | |||
| 27826 | 90 | 242.00 | 210.00 | 3 | |||
| 27827 | 90 | 242.00 | 210.00 | 3 | |||
| 27828 | 90 | 242.00 | 210.00 | 3 | |||
| 27829 | 90 | 305.00 | 263.00 | 3 | |||
| 27830 | 30 | 60.00 | 51.00 | 3 | |||
| 27831 | 30 | 80.00 | 68.00 | 3 | |||
| 27832 | 90 | 164.00 | 142.00 | 3 | |||
| 27840 | 45 | 61.00 | 53.00 | 0 | |||
| 27842 | 45 | 61.00 | 53.00 | 3 | |||
| 27846 | 90 | 305.00 | 263.00 | 3 | |||
| 27848 | 60 | 275.00 | 233.00 | 3 | |||
| 27860 | 0 | 61.00 | 53.00 | 3 | |||
| 27870 | 90 | 302.00 | 263.00 | 3 | |||
| 27871 | 90 | 302.00 | 263.00 | 3 | |||
| 27880 | 90 | 242.00 | 210.00 | 3 | |||
| 27881 | 60 | 266.00 | 226.00 | 3 | |||
| 27882 | 90 | 155.00 | 137.00 | 4 | |||
| 27884 | 0 | 63.93 | 54.34 | 4 | |||
| 27886 | 90 | 242.00 | 210.00 | 3 | |||
| 27888 | 90 | 242.00 | 210.00 | 3 | |||
| 27889 | 60 | 242.00 | 210.00 | 3 | |||
| 27892 | 90 | 127.00 | 108.00 | 3 | |||
| 27893 | 90 | 127.00 | 108.00 | 3 | |||
| 27894 | 90 | 147.00 | 125.00 | 3 | |||
| 28001 | 0 | 31.48 | 26.76 | 3 | |||
| 28002 | 0 | 49.26 | 41.87 | 3 | |||
| 28003 | 30 | 100.00 | 85.00 | 3 | |||
| 28005 | 30 | 150.00 | 128.00 | 3 | |||
| 28008 | 60 | 61.00 | 53.00 | 3 | |||
| 28010 | 0 | 25.77 | 21.90 | 3 | |||
| 28011 | 0 | 37.00 | 32.00 | 3 | |||
| 28020 | 60 | 109.00 | 95.00 | 3 | |||
| 28022 | 60 | 109.00 | 95.00 | 3 | |||
| 28024 | 60 | 52.18 | 44.35 | 3 | |||
| 28030 | 30 | 143.00 | 122.00 | 3 | |||
| 28035 | 30 | 171.00 | 146.00 | 3 | |||
| 28043 | 0 | 45.16 | 38.39 | 3 | |||
| 28045 | 0 | 57.00 | 49.00 | 3 | |||
| 28046 | 60 | 228.00 | 194.00 | 3 | |||
| 28050 | 30 | 171.00 | 146.00 | 3 | |||
| 28052 | 30 | 103.00 | 88.00 | 3 | |||
| 28054 | 30 | 86.00 | 74.00 | 3 | |||
| 28060 | 30 | 143.00 | 122.00 | 3 | |||
| 28062 | 60 | 228.00 | 194.00 | 3 | |||
| 28070 | 30 | 171.00 | 146.00 | 3 | |||
| 28072 | 30 | 103.00 | 88.00 | 3 | |||
| 28080 | 30 | 121.00 | 105.00 | 3 | |||
| 28086 | 30 | 160.00 | 136.00 | 3 | |||
| 28088 | 30 | 114.00 | 97.00 | 3 | |||
| 28090 | 30 | 90.00 | 79.00 | 3 | |||
| 28092 | 30 | 61.00 | 53.00 | 3 | |||
| 28100 | 60 | 121.00 | 105.00 | 4 | |||
| 28102 | 60 | 200.00 | 170.00 | 3 | |||
| 28103 | 60 | 200.00 | 170.00 | 3 | |||
| 28104 | 30 | 143.00 | 122.00 | 4 | |||
| 28106 | 60 | 200.00 | 170.00 | 3 | |||
| 28107 | 60 | 200.00 | 170.00 | 3 | |||
| 28108 | 60 | 121.00 | 105.00 | 4 | |||
| 28110 | 30 | 69.00 | 59.00 | 3 | |||
| 28111 | 30 | 171.00 | 146.00 | 3 | |||
| 28112 | 30 | 103.00 | 88.00 | 3 | |||
| 28113 | 30 | 103.00 | 88.00 | 3 | |||
| 28114 | 90 | 242.00 | 210.00 | 3 | |||
| 28116 | 30 | 171.00 | 146.00 | 3 | |||
| 28118 | 30 | 143.00 | 122.00 | 3 | |||
| 28119 | 30 | 143.00 | 122.00 | 3 | |||
| 28120 | 60 | 90.00 | 79.00 | 4 | |||
| 28122 | 60 | 90.00 | 79.00 | 4 | |||
| 28124 | 60 | 90.00 | 79.00 | 4 | |||
| 28126 | 30 | 143.00 | 122.00 | 3 | |||
| 28130 | 90 | 211.00 | 184.00 | 3 | |||
| 28140 | 60 | 121.00 | 105.00 | 3 | |||
| 28150 | 90 | 90.00 | 79.00 | 3 | |||
| 28153 | 30 | 69.00 | 59.00 | 3 | |||
| 28160 | 90 | 90.00 | 79.00 | 3 | |||
| 28171 | 90 | 371.00 | 316.00 | 3 | |||
| 28173 | 90 | 371.00 | 316.00 | 3 | |||
| 28175 | 90 | 371.00 | 316.00 | 3 | |||
| 28190 | 0 | 29.14 | 24.77 | 3 | |||
| 28192 | 30 | 52.85 | 44.92 | 4 | |||
| 28193 | 30 | 59.81 | 50.84 | 4 | |||
| 28200 | 90 | 121.00 | 105.00 | 3 | |||
| 28202 | 30 | 161.00 | 137.00 | 3 | |||
| 28208 | 90 | 61.00 | 53.00 | 3 | |||
| 28210 | 30 | 103.00 | 88.00 | 3 | |||
| 28220 | 60 | 113.00 | 99.00 | 3 | |||
| 28222 | 60 | 139.00 | 119.00 | 3 | |||
| 28225 | 60 | 113.00 | 99.00 | 3 | |||
| 28226 | 60 | 139.00 | 119.00 | 3 | |||
| 28230 | 30 | 49.26 | 41.87 | 3 | |||
| 28232 | 60 | 139.00 | 119.00 | 3 | |||
| 28234 | 60 | 139.00 | 119.00 | 3 | |||
| 28238 | 30 | 171.00 | 146.00 | 3 | |||
| 28240 | 30 | 61.00 | 53.00 | 3 | |||
| 28250 | 30 | 143.00 | 122.00 | 3 | |||
| 28260 | 30 | 171.00 | 146.00 | 3 | |||
| 28261 | 60 | 200.00 | 170.00 | 3 | |||
| 28262 | 60 | 212.00 | 184.00 | 3 | |||
| 28264 | 60 | 285.00 | 243.00 | 3 | |||
| 28270 | 30 | 69.00 | 59.00 | 3 | |||
| 28272 | 30 | 44.48 | 37.80 | 3 | |||
| 28280 | 45 | 61.00 | 53.00 | 3 | |||
| 28285 | 90 | 90.00 | 79.00 | 3 | |||
| 28286 | 30 | 68.00 | 57.00 | 3 | |||
| 28288 | 21 | 72.00 | 63.00 | 3 | |||
| 28289 | 90 | 228.00 | 194.00 | 3 | |||
| 28290 | 60 | 90.00 | 79.00 | 3 | |||
| 28292 | 90 | 139.00 | 121.00 | 3 | |||
| 28293 | 90 | 242.00 | 210.00 | 3 | |||
| 28294 | 90 | 141.00 | 123.00 | 3 | |||
| 28296 | 60 | 200.00 | 170.00 | 3 | |||
| 28305 | 60 | 217.00 | 185.00 | 3 | |||
| 28306 | 90 | 113.00 | 100.00 | 3 | |||
| 28307 | 60 | 217.00 | 185.00 | 3 | |||
| 28308 | 90 | 113.00 | 100.00 | 3 | |||
| 28309 | 60 | 257.00 | 219.00 | 3 | |||
| 28310 | 30 | 69.00 | 59.00 | 3 | |||
| 28312 | 30 | 58.55 | 49.77 | 3 | |||
| 28313 | 90 | 90.00 | 79.00 | 3 | |||
| 28315 | 60 | 55.00 | 47.00 | 3 | |||
| 28320 | 60 | 200.00 | 170.00 | 3 | |||
| 28322 | 30 | 143.00 | 122.00 | 3 | |||
| 28340 | 90 | 90.00 | 79.00 | 3 | |||
| 28341 | 90 | 90.00 | 79.00 | 3 | |||
| 28344 | 45 | 63.12 | 53.65 | 3 | |||
| 28345 | 90 | 90.00 | 79.00 | 3 | |||
| 28400 | 30 | 68.00 | 59.00 | 3 | |||
| 28405 | 90 | 90.00 | 79.00 | 3 | |||
| 28406 | 60 | 228.00 | 194.00 | 3 | |||
| 28415 | 90 | 151.00 | 131.00 | 3 | |||
| 28420 | 90 | 300.00 | 255.00 | 3 | |||
| 28430 | 30 | 82.00 | 72.00 | 3 | |||
| 28435 | 90 | 90.00 | 79.00 | 3 | |||
| 28436 | 30 | 175.00 | 149.00 | 3 | |||
| 28445 | 60 | 275.00 | 234.00 | 3 | |||
| 28450 | 30 | 41.00 | 36.00 | 3 | |||
| 28455 | 90 | 61.00 | 53.00 | 3 | |||
| 28456 | 30 | 121.00 | 103.00 | 3 | |||
| 28465 | 90 | 121.00 | 105.00 | 3 | |||
| 28470 | 30 | 24.58 | 20.72 | 3 | |||
| 28475 | 90 | 42.00 | 37.00 | 3 | |||
| 28476 | 30 | 82.00 | 70.00 | 3 | |||
| 28485 | 90 | 90.00 | 79.00 | 3 | |||
| 28490 | 30 | 18.00 | 16.00 | 3 | |||
| 28495 | 30 | 30.00 | 26.00 | 3 | |||
| 28496 | 30 | 60.00 | 51.00 | 3 | |||
| 28505 | 30 | 120.00 | 102.00 | 3 | |||
| 28510 | 30 | 18.00 | 16.00 | 3 | |||
| 28515 | 30 | 30.00 | 26.00 | 3 | |||
| 28525 | 30 | 90.00 | 77.00 | 3 | |||
| 28530 | 30 | 18.00 | 16.00 | 3 | |||
| 28531 | 30 | 59.00 | 50.00 | 3 | |||
| 28540 | 45 | 61.00 | 53.00 | 0 | |||
| 28545 | 45 | 61.00 | 53.00 | 3 | |||
| 28546 | 30 | 69.00 | 59.00 | 3 | |||
| 28555 | 90 | 211.00 | 184.00 | 3 | |||
| 28570 | 45 | 61.00 | 53.00 | 0 | |||
| 28575 | 45 | 61.00 | 53.00 | 3 | |||
| 28576 | 45 | 118.00 | 100.00 | 3 | |||
| 28585 | 90 | 211.00 | 184.00 | 3 | |||
| 28600 | 45 | 61.00 | 53.00 | 0 | |||
| 28605 | 45 | 61.00 | 53.00 | 3 | |||
| 28606 | 30 | 69.00 | 59.00 | 3 | |||
| 28615 | 30 | 143.00 | 122.00 | 3 | |||
| 28630 | 45 | 61.00 | 53.00 | 0 | |||
| 28635 | 7 | 65.00 | 55.00 | 3 | |||
| 28636 | 7 | 85.00 | 72.00 | 3 | |||
| 28645 | 90 | 121.00 | 105.00 | 3 | |||
| 28660 | 0 | 16.00 | 14.00 | 0 | |||
| 28665 | 0 | 35.00 | 30.00 | 3 | |||
| 28666 | 45 | 80.00 | 68.00 | 3 | |||
| 28675 | 60 | 65.73 | 55.87 | 3 | |||
| 28705 | 90 | 361.00 | 307.00 | 3 | |||
| 28715 | 90 | 272.00 | 236.00 | 3 | |||
| 28725 | 90 | 182.00 | 158.00 | 3 | |||
| 28730 | 60 | 203.00 | 173.00 | 3 | |||
| 28735 | 60 | 226.00 | 192.00 | 3 | |||
| 28737 | 60 | 200.00 | 170.00 | 3 | |||
| 28740 | 90 | 166.00 | 126.00 | 3 | |||
| 28750 | 90 | 90.00 | 79.00 | 3 | |||
| 28755 | 90 | 90.00 | 79.00 | 3 | |||
| 28760 | 90 | 200.00 | 173.00 | 3 | |||
| 28800 | 90 | 211.00 | 184.00 | 3 | |||
| 28805 | 90 | 211.00 | 184.00 | 3 | |||
| 28810 | 90 | 121.00 | 105.00 | 3 | |||
| 28820 | 45 | 63.67 | 54.12 | 3 | |||
| 28820 | 50 | 45 | 94.96 | 80.71 | 3 | ||
| 28825 | 45 | 60.94 | 51.80 | 3 | |||
| 28825 | 50 | 45 | 90.89 | 77.25 | 3 | ||
| 28899 | 0 | B.R. | B.R. | 0 | |||
| 29345 | 0 | 53.00 | 42.00 | 3 | |||
| 29355 | 0 | 47.00 | 42.00 | 3 | |||
| 29358 | 2 | 41.00 | 34.85 | 3 | |||
| 29365 | 0 | 53.00 | 42.00 | 3 | |||
| E D | 29405 | 0 | 42.00 | 37.00 | 3 | ||
| E D | 29425 | 0 | 47.00 | 42.00 | 3 | ||
| E D | 29435 | 0 | 66.00 | 53.00 | 3 | ||
| E D | 29440 | 0 | 12.00 | 10.00 | 3 | ||
| E D | 29450 | 0 | 24.00 | 21.00 | 3 | ||
| E D | 29450 | 50 | 0 | 37.00 | 32.00 | 3 | |
| E D | 29505 | 0 | 48.00 | 42.00 | 3 | ||
| E D | 29515 | 0 | 42.00 | 37.00 | 3 | ||
| E D | 29540 | 0 | 18.00 | 16.00 | 3 | ||
| E D | 29550 | 0 | 16.00 | 14.00 | 3 | ||
| E D | 29580 | 0 | 18.00 | 16.00 | 3 | ||
| E D | 29590 | 0 | 12.00 | 10.00 | 3 | ||
| E D | 29700 | 0 | 14.00 | 12.00 | 3 | ||
| E D | 29705 | 0 | 14.00 | 12.00 | 3 | ||
| E D | 29730 | 0 | 9.00 | 8.00 | 3 | ||
| E D | 29740 | 0 | 11.05 | 9.39 | 3 | ||
| E D | 29750 | 0 | 11.32 | 9.62 | 3 | ||
| E D | 29750 | 50 | 0 | 15.00 | 13.00 | 3 | |
| E D | 29799 | 0 | B.R. | B.R. | 0 | ||
| 29891 | 90 | 236.00 | 201.00 | 3 | |||
| 29892 | 90 | 243.00 | 206.00 | 3 | |||
| 29893 | 90 | 137.00 | 116.00 | 3 | |||
| 29894 | 30 | 100.00 | 85.00 | 3 | |||
| 29895 | 90 | 200.00 | 170.00 | 4 | |||
| 29897 | 60 | 100.00 | 85.00 | 3 | |||
| 29898 | 60 | 150.00 | 128.00 | 3 | |||
| 29899 | 90 | 225.00 | 191.00 | 3 | |||
| 29909 | 0 | BR | BR | 0 | |||
| 29999 | 90 | BR | BR | 3 | |||
| E D | 36410 | 0 | 18.00 | 16.00 | 0 | ||
| E N D | 36415 | 0 | 1.80 | 1.80 | 0 | ||
| 36470 | 0 | 16.70 | 14.19 | ||||
| 36471 | 0 | 20.03 | 17.02 | ||||
| E | 64450 | 0 | 18.00 | 16.00 | 0 | ||
| 64614 | 10 | 77.00 | 65.00 | 0 | |||
| 64702 | 90 | 79.00 | 68.00 | 3 | |||
| 64704 | 90 | 105.00 | 91.00 | 3 | |||
| 64708 | 90 | 242.00 | 210.00 | 3 | |||
| 64726 | 90 | 90.00 | 77.00 | 3 | |||
| 64774 | 30 | 45.96 | 39.06 | 3 | |||
| 64776 | 30 | 53.00 | 45.00 | 3 | |||
| 64778 | 30 | 30.00 | 26.00 | 3 | |||
| 64782 | 30 | 79.00 | 68.00 | 3 | |||
| 64783 | 30 | 70.00 | 60.00 | 3 | |||
| 64784 | 30 | 131.00 | 114.00 | 4 | |||
| 64831 | 90 | 79.00 | 68.00 | 3 | |||
| 64832 | 30 | 43.00 | 37.00 | 3 | |||
| 64834 | 90 | 105.00 | 91.00 | 3 | |||
| 64856 | 90 | 210.00 | 183.00 | 3 | |||
| 64857 | 90 | 158.00 | 137.00 | 3 | |||
| 97601 | 0 | 35.00 | 30.00 | 0 |
NOTE: "+" means that these add-on codes are always performed in addition to the primary procedure only, by the same practitioner. These add-on codes are exempt from multiple surgical pricing methodologies.
(c) RADIOLOGY
| IND | HCPCS Code | Mod | Maximum Fee Allowance S | $ | NS | Annes Basic Units |
| 73600 | 10.00 | 3 | ||||
| 73600 | 26 | 3.60 | ||||
| 73600 | TC | 6.40 | ||||
| 73610 | 13.00 | 3 | ||||
| 73610 | 26 | 5.40 | ||||
| 73610 | TC | 7.60 | ||||
| 73615 | 28.80 | 3 | ||||
| 73615 | 26 | 10.80 | ||||
| 73615 | TC | 18.00 | ||||
| 73620 | 10.00 | 3 | ||||
| 73620 | 26 | 3.60 | ||||
| 73620 | TC | 6.40 | ||||
| 73630 | 13.00 | 3 | ||||
| 73630 | 26 | 5.40 | ||||
| 73630 | TC | 7.60 | ||||
| 73650 | 10.00 | 3 | ||||
| 73650 | 26 | 3.60 | ||||
| 73650 | TC | 6.40 | ||||
| 73660 | 5.00 | 3 | ||||
| 73660 | 26 | 3.60 | ||||
| 73660 | TC | 1.40 |
(d) PATHOLOGY & LABORATORY SERVICES
| IND | HCPCS Code | Mod | Maximum Fee Allowance |
| 81000 | 1.20 | ||
| 82948 | 1.50 | ||
| 85002 | 1.20 | ||
| 85008 | 1.20 | ||
| 86671 | 15.00 | ||
| 87070 | 9.00 | ||
| 87076 | 6.00 | ||
| 87084 | 3.00 | ||
| 87101 | 8.00 | ||
| 87102 | 8.00 | ||
| 87103 | 8.00 | ||
| 87106 | 8.00 | ||
| 87210 | 2.40 | ||
| 87220 | 2.40 |
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.
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