New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 61 - INDEPENDENT CLINICAL LABORATORIES
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM HCPCS
Section 10:61-3.1 - Purpose, scope and general provisions

Universal Citation: NJ Admin Code 10:61-3.1

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

(a) The Medicaid/NJ FamilyCare program uses the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS), for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act, of 1996, 42 U.S.C. §§ 1320d et seq., and the American Medical Association (AMA) Current Procedural Terminology (CPT) codes published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. The HCPCS and CPT codes are incorporated herein by reference, as amended and supplemented. AMA and CMS revisions to the CPT codes and the Healthcare Common Procedure Coding System (code additions, code deletions and replacement codes) will be reflected in this chapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing and new reimbursement amounts codes specified by the Department and specification of new reimbursement amounts for new codes will be made through rulemaking in accordance with the Administrative Procedure Act, 52:14B-1 et seq. HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology (CPT) (American Medical Association, P.O. Box 10950, Chicago, IL 60610.) architecture, employing a five-position code and as many as two two-position modifiers. Unlike the CPT numeric design, the CMS-assigned codes and modifiers contain alphabetic characters.

(b) HCPCS has been developed as a three-level coding system. The CPT procedure narratives for Level I codes are incorporated herein by reference.

1. Level 1 codes (Narratives found in CPT). CPT is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical services and procedures performed by physicians. (See 10:61-3.2.)

2. Level II codes are assigned by CMS for physician and non-physician services which are not in CPT. (See 10:61-3.3.)

3. Level III codes identify services unique to the Medicaid/NJ FamilyCare program. These codes are assigned by the Division to be used for those services not identified by CPT codes or CMS-assigned codes. (See 10:61-3.4.)

(c) The lists of HCPCS code numbers for Pathology and Laboratory are arranged in tabular form with specific information for a code identified under columns with titles such as: "IND," "HCPCS CODE," "MOD," "DESCRIPTION," and "MAXIMUM FEE ALLOWANCE." The information identified under each column is summarized below:

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(d) When alphabetic and numeric symbols are listed under the "IND" and "MOD" columns they are qualifiers or indicators (in the "IND" column) and as modifiers (in the "MOD" column). The symbols assist the provider in determining the appropriate procedure codes to be used, the area to be covered, the minimum requirements needed, and any additional parameters required for reimbursement purposes.

1. These symbols and/or letters must not be ignored because in certain instances requirements are created in addition to the narrative which accompanies the CPT/HCPCS procedure code as written in CPT. The provider will then be liable for the additional requirements and not just the CPT/HCPCS procedure code narrative. These requirements must be fulfilled in order to receive reimbursement.

2. If there is no identifying symbol listed, the CPT/HCPCS code narrative prevails.

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