New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58 - NURSE MIDWIFERY SERVICES
Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES CMS HEALTHCARE COMMON PROCEDURE CODING SYSTEM HCPCS
Section 10:58-3.2 - Elements of HCPCS Procedure Codes which require attention of the certified nurse midwife
Universal Citation: NJ Admin Code 10:58-3.2
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The list of HCPCS procedure codes for nurse midwifery services are arranged in tabular form with specific information for a code given under columns with titles such as: "IND," "HCPCS CODE," "MOD," "DESCRIPTION," "FOLLOW-UP DAYS," "MAXIMUM FEE ALLOWANCE SCHEDULE" and "ANESTHESIA BASIC UNITS." The information given under each column is summarized below:
| Column Title | |
| "IND" | (Indicator-Qualifier) Lists alphabetic symbols used to refer |
| a provider to information concerning the New Jersey Medicaid/ | |
| NJ FamilyCare programs' qualifications and requirements when | |
| a HCPCS procedure code is used. | |
| Explanation of indicators and qualifiers used in this column | |
| are given below: | |
| "N" | Preceding any procedure code means that qualifiers are |
| applicable to that code. | |
| "HCPCS CODES"--Lists the HCPCS procedure codes. | |
| "MOD" | Lists alphabetic and numeric symbols. Services and procedures |
| may be modified under certain circumstances. When applicable, | |
| the modifying circumstance is identified by the addition of | |
| alphabetic and/or numeric characters affixed to the code. The | |
| modifiers are as follow: | |
| "SB" | Midwifery: Used to identify procedures performed by CNM by |
| adding the modifier "SB" to the procedure code. | |
| "22" | Unusual Services: When the service(s) provided is greater |
| than that usually required for the listed procedure, it may | |
| be identified by affixing "22" after the usual procedure | |
| number. | |
| "52" | Reduced Services: Under certain circumstances, a service or |
| procedure is partially reduced or eliminated. Under these | |
| circumstances, the service provided can be identified by its | |
| usual procedure number and the addition of the modifier "52", | |
| signifying that the service is reduced. This provides a means | |
| of reporting reduced services without disturbing the | |
| identification of the basic service. | |
| "DESCRIPTION"--Lists the code narrative for Level II and III codes. | |
| Narratives for Level I codes are found in the CPT. | |
| "FOLLOW-UP"--Lists the number of days for follow-up. | |
| "MAXIMUM FEE ALLOWANCE"--Lists the New Jersey Medicaid/NJ FamilyCare | |
| programs' reimbursement schedule for nurse midwifery services. | |
| "ANESTHESIA BASIC UNITS"--B.U.V. (Basic Unit Value) | |
1. These symbols when listed under the "IND" and "MOD" columns are elements of the HCPCS coding system used as qualifiers or indicators (as in the "IND" column) and as modifiers (as in the "MOD" column). They assist the CNM in determining the appropriate procedure codes to be used, the area to be covered, the minimum requirements needed, and any additional parameters required to be eligible for reimbursement.
i. These symbols and/or letters must not be ignored, because in certain instances there are requirements in addition to the narrative, which accompanies the HCPCS procedure code as described in the CPT. The CNM is responsible for all the requirements and not just the code narrative as described in the CPT. All the described requirements in the CPT must be fulfilled in order to be eligible for reimbursement.
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