New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 62 - VISION CARE SERVICES MANUAL
Subchapter 1 - EYE CARE: PROFESSIONAL SERVICES
Section 10:62-1.22 - Reimbursement policies
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Instructions for submitting claims for payment of vision care services are provided in the Fiscal Agent Billing Supplement.
(b) Vision care services shall be identified by means of procedure codes, utilizing the CMS Healthcare Common Procedure Coding System (HCPCS). The codes and maximum fee allowance schedule are listed in N.J.A.C. 10:62-3.
(c) The provider shall use the practitioner's usual and customary charge when submitting a claim for vision care services. Reimbursement for covered services furnished under the New Jersey Medicaid/NJ FamilyCare fee-for-service programs shall be made on the basis of the provider's customary charge, not to exceed an allowance determined to be reasonable by the Commissioner of the Department of Human Services, and further limited by Federal policy ( 42 CFR 447 Subpart B) relative to payment of practitioners and other individual providers.
(d) For reimbursement purposes, when the practitioner submits a claim for services, the services shall have been performed personally by the practitioner submitting the claim.