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 10:58-3.4 - HCPCS Procedure Codes (Level II) and maximum fee allowance schedule for certified nurse midwifery services
Universal Citation: NJ Admin Code 10:58-3.4
Current through Register Vol. 56, No. 18, September 16, 2024
| HCPCS | Maximum Fee | |
|---|---|---|
| Codes | Descriptions | Allowance |
| J2790 | RhoGAM, Rho (D) Immune | $ 26.00 |
| Globulin (Human) | ||
| Single dose (Micro-Dose) | ||
| J2790 22 | RhoGAM, Rho (D) Immune | $ 45.00 |
| Globulin (Human) | ||
| Single dose (Full dose) | ||
| (22--Services greater than usual) | ||
| J1050 | Medroxyprogesterone acetate, 100 mg | 9.05 |
| J1055 | Medroxyprogesterone acetate for | 44.54 |
| contraceptive use, 150 mg | ||
| J1056 | Lunelle (25mg medroxyprogesterone and 5 mg | Lower of AWP |
| estradiol cypionate)/0.5 ml | minus 12.5 | |
| percent or the | ||
| acquisition | ||
| cost + | ||
| + Effective September 18, 2006, the Maximum Fee Allowance based on the AWP | ||
| minus 12.5 percent is $ 24.95 per 0.5 ml. Enter the lower of the AWP minus | ||
| 12.5 percent or the acquisition cost in Block 24G on the CMS 1500 claim | ||
| form. | ||
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