New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 66 - INDEPENDENT CLINIC SERVICES
Subchapter 5 - AMBULATORY SURGICAL CENTER (ASC)
Section 10:66-5.1 - Covered services
Universal Citation: NJ Admin Code 10:66-5.1
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Medicaid and NJ FamilyCare fee-for-service covered procedures in an ambulatory surgical center (ASC) are those surgical and medical procedures that appear at 42 CFR 416.166, the Federal regulations governing ASC services.
(b) Medicaid-covered and NJ FamilyCare fee-for-service covered surgical procedures include, but are not limited to, those procedures that:
1. Are
commonly performed in a hospital, but may be safely performed in an ASC;
i. Are not commonly or safely performed in a
physician's office;
2.
Require a dedicated operating room or suite, and require a postoperative
recovery room or short-term, meaning not overnight, convalescent room;
3. Do not generally exceed a total
of 90 minutes operating time and four hours recovery or convalescent time;
and
4. Are not emergent or life
threatening in nature, for example:
i. Do not
generally result in extensive blood loss;
ii. Do not require major or prolonged
invasion of body cavities; or
iii.
Do not directly involve major blood vessels.
(c) For reimbursement information for ASC services, see N.J.A.C. 10:66-1.5.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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