New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58 - NURSE MIDWIFERY SERVICES
Subchapter 2 - PROVISIONS FOR SPECIFIC SERVICES
Section 10:58-2.4 - Evaluation and management: preventive medicine

Universal Citation: NJ Admin Code 10:58-2.4

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

(a) In the absence of patient complaints, the procedure codes identified as preventive medicine services shall be used for adults and for children.

(b) Preventive medicine services codes (new patient) are comparable, in respect to reimbursement level, to an initial visit and, therefore, shall only be billed once per patient, per year. These codes shall be denied when the beneficiary is seen by the same practitioner, group of practitioners, or involves a shared health care facility sharing a common record. Preventive visits (established patient) for adults shall be considered an annual health maintenance visit.

(c) Requirements for preventive medicine services, the annual health maintenance examination, for new or established patients under the age of 21 are as follows:

1. These codes are not allowable for payment when used following an EPSDT examination performed within the preceding 12 months for a child older than two years of age; and

2. Preventive medicine codes may be used in accordance with the periodicity schedule of preventive visits recommended by the American Academy of Pediatrics. (See 10:58-2.8 through 2.12.)

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