New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58 - NURSE MIDWIFERY SERVICES
Subchapter 2 - PROVISIONS FOR SPECIFIC SERVICES
Section 10:58-2.2 - Evaluation and management: initial visits
Current through Register Vol. 56, No. 18, September 16, 2024
(a) For office visits and for other care apart from inpatient hospital, CNMs shall bill for an initial visit only once for a specific patient, subject to the exceptions contained in (b) below. When a shared health care facility, a group of physicians and/or other practitioners (CNMs) share a common record, the Division will reimburse only one initial visit. Further encounters with that patient will be billed and reimbursed by means of "established patient" codes. (See 10:58-3.1 through 3.5.)
(b) In the inpatient hospital setting, the initial visit concept still applies for reimbursement purposes, except that subsequent readmissions to the same facility may be designated as initial visits as long as a time interval of 30 days or more has elapsed between admissions.
(c) An initial hospital visit will be disallowed to the same practitioner, group of practitioners, shared health care facility, or practitioners sharing a common record who submit a claim for a consultation and transfer the patient to their service.
(d) In order to use the HCPCS procedure code to bill for an initial visit, the CNM shall provide the minimal documentation in the record regardless of the setting where the examination was performed. See 10:58-1.8(c).
