New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 62 - VISION CARE SERVICES MANUAL
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:62-3.4 - Qualifier for professional vision care services
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Qualifiers for professional vision care services are summarized below:
|
HCPCS |
Procedure |
|
Codes |
| 92002 | Comprehensive Eye Examination--Refers to a |
| 92004 | new or established patient. |
| 92012 | |
| 92014 |
| 92004 | 22 | Comprehensive Eye Examination with Diagnostic |
| 92014 | 22 | Fields--Refers to a new or established patient. |
| 92020 | Independent Office Procedures--HCPCS |
| 92065 | 92020, 92065, 92081, 92082, 92083, 92100, |
| 92081 | 92120, 92130, 92140, 92260, |
| 92082 | shall notbereimbursable |
| 92083 | when performedonthe same day as HCPCS |
| 92100 | 92002, 92004, 92012 or 92014. |
| 92120 | |
| 92130 | |
| 92140 | |
| 92260 |
Codes 99201, 99202, 99203, 99204, 99205, 99301, 99302, 99303, 99321, 99322 and 99323 shall not be reimbursable with 92002, 92004, 92012 or 92014 on the same day.
Codes 99211, 99212, 99213, 99214, 99215, 99311, 99312 and 99313 shall not be reimbursable with 92002, 92004, 92012 or 92014 on the same day.
Physician's Use of Emergency Room Instead of Office:
| 99211 | When a physician sees his/her patient in the emer- |
| 99212 | gency room instead of his/her office, the physician |
| 99213 | shall use the same HCPCS for the visit that would |
| 99214 | have been used if seen in the physician's office |
| 99215 | (99211, 99212, 99213, 99214 or 99215 only). |
Hospital-Based Emergency Room Physicians:
| 99281 | When patients are seen by hospital-based emer- |
| 99282 | gency room physicians who are eligible to bill the |
| 99283 | Medicaid/NJ FamilyCare program, then the ap- |
| 99284 | propriate HCPCS is used. The "Visit" codes shall |
| 99285 | be limited to 99281, 99282, 99283, 99284 and 99285. |
| 92280 | Not reimbursable for initial testing, general screening, research |
| studies or any situation where usefulness has not been clearly | |
| established; and therefore, it is without controversy. | |
| Code 92280--for reimbursement purposes refers to a visual | |
| brain-stem-evoked response (VBR) with interpretation. Reimbursable | |
| to hospital outpatient department as a hospital charge or to a | |
| qualified provider (office setting). The study must be personally | |
| performed by any of the following disciplines trained and | |
| experienced with VBR testing, namely Ophthalmologists, Optometrists, | |
| Neurologists, Neurosurgeons, and Psychiatrists. Criteria for | |
| testing: |
| i. | Inconclusive test results by standard vision testing for: |
| (1) | Neonates and infants at risk for vision loss; |
| (2) | Children and adults who cannot perform behavioral testing. |
| ii. | Suspected organic neurologic lesion within or proximal to the |
| visual pathway. |
Code 99082 may be used for travel costs only associated and billed with HOUSE CALL OR HOME VISIT. (See HCPCS 99341, 99342, 99343, 99347, 99348 and 99349.)
| Home Visit--99343 and 99349 |
| The Home Visit HCPCS 99343 and 99349 does not distinguish |
| between specialist and non-specialist. These codes shall not |
| apply to residential health care facility or nursing facility |
| settings. These codes 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/her physical condition. When billing for a second or |
| subsequent patient treated during the same visit, the visit |
| should be billed as a home visit. |
| Home Visit--99341, 99342, 99344, 99345, 99347, 99348 and 99349 |
| These HCPCS apply when the provider visits a beneficiary in the |
| home and the visit does not meet the criteria specified under a |
| House Call listed in 10:62-1.13. |
