New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58 - NURSE MIDWIFERY SERVICES
Subchapter 2 - PROVISIONS FOR SPECIFIC SERVICES
Section 10:58-2.10 - Clinical laboratory services provided by a CNM

Universal Citation: NJ Admin Code 10:58-2.10

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

(a) A CNM may claim reimbursement for clinical laboratory services performed for his or her own patients within his or her own office, except when provided in a birth center. Laboratory services provided in a birth center shall be billed to Medicaid/NJ FamilyCare-Plan A fee-for-service programs by the center.

1. A CNM shall meet the conditions of the CLIA regulations before she or he may perform clinical laboratory testing for Medicaid/NJ FamilyCare-Plan A fee-for-service beneficiaries; and

2. The clinical laboratory tests shall be standard clinical laboratory procedures consistent with the CNM's CLIA certification, certificate of waiver or certificate of registration.

(b) Profiles are components of a test or series of tests which are frequently performed or automated. Examples of identifiable laboratory profiles or studies are as follow:

1. Obstetrical Profile;

2. The components of an SMA (Sequential Multichannel Automated Analysis) 12/60 or other automated laboratory study; or

3. Inclusion of blood indices, such as MCH (Mean Corpuscular Hemoglobin), MCV (Mean Corpuscular Volume), as a component of a CBC (Complete Blood Count).

(c) If the components of a profile are billed separately, reimbursement for the components of the profile (panel) shall not exceed the Medicaid/NJ FamilyCare fee allowance for the profile itself.

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