New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 62 - VISION CARE SERVICES MANUAL
Subchapter 1 - EYE CARE: PROFESSIONAL SERVICES
Section 10:62-1.14 - Home services

Universal Citation: NJ Admin Code 10:62-1.14

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

(a) The home visit HCPCS 99343 and 99353 shall not apply to residential health care facility or nursing facility settings. These HCPCS refer to a physician visit limited to the provision of medical care to an individual who would be too ill to go to a physician's office and/or is "home bound" due to his or her physical condition. When billing for a second or subsequent patient treated during the same visit, the visit shall be billed as a home visit.

(b) For purposes of New Jersey Medicaid/NJ FamilyCare fee-for-service reimbursement, HCPCS 99341, 99342, 99351, and 99352 apply when the provider visits a New Jersey Medicaid/NJ FamilyCare fee-for- service beneficiary in the home setting and the visit does not meet the criteria specified for a home visit in (a) above.

(c) In addition to the recordkeeping requirements indicated in N.J.A.C. 10:62-1.21, the record and documentation of a home visit shall become part of the office progress notes and shall include, as appropriate, the following information:

1. The purpose of the visit;

2. The pertinent history obtained;

3. Pertinent physical findings, including pertinent negative physical findings based on (c)1 and 2 above;

4. The procedures, if any performed, with results;

5. Lab, X-ray ECG, etc., ordered with results; and

6. A diagnosis(es) plus treatment plan status relative to present or pre-existing illness(es) plus pertinent recommendations and actions.

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