New Jersey Administrative Code, Subchapter 6, Section 10:66-6.2 - HCPCS procedure code numbers and maximum fee allowance schedule | New Jersey Administrative Code

(a) Evaluation and management and other procedures

* An asterisk preceding any procedure code may also be performed in a substance use disorder treatment facility.

Follow	Anes.
HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
*N	36415	1.80	1.80
N	67221	90	283.00	241.00
N	67225	23.00	20.00
90746	65.25	65.25
93000	16.00	16.00
93005	11.00	11.00
93010	5.00	5.00
93012	11.00	9.00
93014	5.00	4.25
93015	80.00	68.00
93016	10.00	10.00
93017	35.00	35.00
93018	13.51	11.49
93268	32.00	27.00
93268	TC	19.00	19.00
93268	26	13.00	11.00
93270	17.00	14.00
93271	35.00	30.00
93272	20.00	17.00
96372	2.50	2.50
96373	9.47	8.05
96374	32.22	27.39
96401	36.09	30.68
96402	22.34	18.99
96405	16.00	14.00
96406	20.00	17.00
96409	66.57	56.58
96411	37.94	32.24
96413	90.24	76.70
96415	19.96	16.96
96416	98.05	83.34
96417	44.34	37.69
96420	16.00	14.00
96422	32.00	28.00
96423	16.00	14.00
96425	16.00	14.00
96440	38.00	32.00
96445	38.00	32.00
96450	61.00	52.00
96521	78.82	67.00
96522	62.77	53.35
96542	61.00	52.00
99173	5.00	5.00
N	99201	23.50	20.60
N	99201	SA	NA	19.60
N	99201	SB	NA	16.50
N	99202	23.50	20.60
N	99202	SA	NA	19.60
N	99202	SB	NA	16.50
N	99203	32.30	25.00
N	99203	SA	NA	23.80
N	99203	SB	NA	22.60
N	99203	UD	32.30	25.00
N	*99204	32.30	25.00
N	99204	SA	NA	23.80
N	99204	SB	NA	22.60
N	*99205	32.30	25.00
N	99211	16.00	14.00
N	99211	SA	NA	13.30
N	99211	SB	NA	11.20
N	99212	23.50	20.60
N	99212	SA	NA	19.60
N	99212	SB	NA	16.50
N	*99213	23.50	20.60
N	99213	SA	NA	19.60
N	99213	SB	NA	16.50
N	99213	UD	23.50	20.60
N	*99214	23.50	20.60
N	99214	SA	NA	19.60
N	99214	SB	NA	16.50
N	99215	23.50	20.60
99215	SA	NA	19.60
N	99215	SB	NA	16.50
99217	23.50	20.60
99221	32.30	25.00
99221	SA	NA	23.80
99221	SB	NA	22.60
99222	32.30	25.00
99223	32.30	25.00
99231	23.50	20.60
99231	SA	NA	19.60
99231	SB	NA	16.50
99232	23.50	20.60
99232	SA	NA	19.60
99232	SB	NA	16.50
99233	23.50	20.60
99234	55.90	47.00
99235	55.90	47.00
99236	55.90	47.00
99238	23.50	20.60
99239	23.50	20.60
N	99241	44.00	37.00
N	99242	64.70	54.40
N	99243	64.70	54.40
N	99244	91.10	77.90
99244	SM	73.50	62.50
99244	SN	73.50	62.50
N	99245	91.10	77.90
N	99251	34.50	29.30
N	99252	64.70	54.40
N	99253	64.70	54.40
N	99254	91.10	77.90
N	99255	91.10	77.90
99261	16.00	14.00
99262	23.50	20.60
99263	23.50	20.60
99281	16.00	14.00
99281	SA	NA	13.30
99282	23.50	20.60
99282	SA	NA	19.60
99283	23.50	20.60
99283	SA	NA	19.60
99284	32.30	25.00
99284	SA	NA	23.80
99285	32.30	25.00
N	99291	66.20	58.80
N	99292	33.10	29.40
N	99354	66.20	58.80
N	99354	SA	NA	55.90
N	99355	33.10	29.40
N	99355	SA	NA	27.90
99356	66.20	58.80
99357	33.10	29.40
99381	80.06	68.05
99381	22	80.06	68.05
99381	SA	NA	64.65
99381	EP SA	NA	64.65
99381	22 EP	80.06	68.05
99381	22 SA	NA	64.65
99382	86.53	73.55
99382	EP	86.53	73.55
99382	EP SA	NA	69.87
99382	22 EP	86.53	73.55
99382	SA	NA	69.87
99382	SA 52	NA	69.87
99382	22	86.53	73.55
99382	22 SA	NA	69.87
*99383	85.17	72.39
99383	EP	85.17	72.39
99383	SA	NA	68.77
99383	SA 52	NA	68.77
*99384	92.67	78.77
99384	EP	92.67	78.77
99384	SA	NA	74.83
99384	SA 52	NA	74.83
99384	SB	NA	64.87
*99385	32.30	25.00
99385	EP	92.67	78.77
99385	SA	NA	23.80
99385	SA 52	NA	23.80
99385	SB	NA	22.60
*99386	32.30	25.00
99386	SA	NA	23.80
99386	SB	NA	22.60
*99387	32.30	25.00
99387	SA	NA	23.80
99387	SB	NA	22.60
99391	64.05	54.44
99391	SA	NA	51.72
99391	EP	64.05	54.44
99391	22	64.05	54.44
99391	EP SA	NA	51.72
99391	22 EP	64.05	54.44
99392	71.54	60.81
99392	EP	71.54	60.81
99392	22	71.54	60.81
99392	SA	NA	51.72
99392	22 SA	NA	51.72
99392	EP SA	NA	51.72
99392	22 EP	71.54	60.81
99392	SA 52	NA	51.72
*99393	70.86	60.23
99393	SA	NA	57.22
99393	EP	70.86	60.23
99393	SA 52	NA	57.22
*99394	77.68	66.03
99394	EP	77.68	66.03
99394	SA	NA	62.73
99394	SA 52	NA	62.73
99394	SB	NA	54.38
*99395	32.30	25.00
99395	EP	78.36	66.61
99395	SA	NA	23.80
99395	SA 52	NA	23.80
99395	SB	NA	22.60
99396	32.30	25.00
99396	SA	NA	23.80
99396	SB	NA	22.60
*99397	32.30	25.00
99397	SA	NA	23.80
99397	SB	NA	22.60
99460	51.37	43.66
99460	SA	NA	41.48
99461	73.46	62.44
99463	69.22	58.83
99463	SA	NA	55.89
99464	65.14	55.37
99465	127.74	108.58

(b) Dental services (See N.J.A.C. 10:56-3).

(c) Family planning services:

Follow	Anes.
HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
11975	FP	30	B.R.	B.R.
N	11975	22	30	B.R.	B.R.
11976	FP	90	190.00	190.00
N	11977	22	90	B.R.	B.R.
11981	FP	100.00	100.00
11982	FP	100.00	100.00
11983	FP	180.00	180.00
36415	FP	3.40	3.40
36416	FP	1.80	1.80
54056	FP	32.00	32.00	3
N	55250	30	90.00	79.00	3
N	55450	30	42.00	37.00	3
56501	FP	29.00	29.00	3
56820	FP	30	88.00	NA
56821	FP	30	113.00	NA
57420	FP	71.00	NA	3
57421	FP	15	93.00	NA	3
57452	FP	39.90	39.90	3
57454	FP	64.60	64.60	3
57511	FP	45	45.60	45.60	3
58300	FP	30	74.10	74.10	3
58300	SA FP	30	NA	29.85	3
58300	SB FP	30	NA	29.85	3
58301	16.40	16.40
58301	FP	31.20	31.20
58301	SA FP	NA	16.40	3
58301	SB FP	NA	16.40
81000	FP	1.20	1.20
81002	FP	1.00	1.00
81025	FP	3.00	3.00
82465	FP	3.00	3.00
82947	FP	4.34	4.34
82948	FP	1.50	1.50
85013	FP	1.50	1.50
85018	FP	2.00	2.00
86592	FP	1.50	1.50
86701	FP	12.00	12.00
86762	FP	12.00	12.00
87086	FP	6.00	6.00
87184	FP	9.00	9.00
87270	FP	10.00	10.00
87274	FP	12.80	12.80
87320	FP	12.50	12.50
87490	FP	20.00	20.00
87491	FP	38.00	38.00
87590	FP	25.00	25.00
87591	FP	38.00	38.00
87620	FP	25.00	25.00
87621	FP	38.00	38.00
88141	FP	6.00	6.00
88142	FP	18.00	18.00
88143	FP	18.00	18.00
88148	FP	13.48	13.48
88150	FP	6.00	6.00
88151	6.00	6.00
88152	FP	6.00	6.00
88153	FP	6.00	6.00
88154	FP	6.00	6.00
88164	FP	6.00	6.00
88165	FP	6.00	6.00
88166	FP	6.00	6.00
88167	FP	6.00	6.00
88305	FP	40.00	40.00
90471	FP	16.18	16.18
90649	FP	153.25	153.25
90671	FP	16.18	16.18
96372	FP	4.80	4.80
N	99201	FP	83.70	83.70
N	99201	FP SB	NA	31.50
N	99201	FP 52	79.70	79.70
N	99202	FP	83.70	83.70
N	99202	FP SB	NA	31.50
N	99202	FP 52	79.70	79.70
N	99203	FP	83.70	83.70
N	99203	FP SB	NA	31.50
N	99203	FP 52	79.70	79.70
N	99204	FP	83.70	83.70
N	99204	FP SB	NA	31.50
N	99204	FP 52	79.70	79.70
N	99205	FP	83.70	83.70
N	99205	FP SB	NA	31.50
N	99205	FP 52	79.70	79.70
N	99211	FP	41.90	41.90
N	99211	FP SB	NA	16.40
N	99211	FP 52	37.90	37.90
N	99212	FP	41.90	41.90
N	99212	FP SB	NA	16.40
N	99212	FP 52	37.90	37.90
N	99213	FP	41.90	41.90
N	99213	FP SB	NA	16.40
N	99213	FP 52	37.90	37.90
N	99214	FP	41.90	41.90
N	99214	FP SB	NA	16.40
N	99214	FP 52	37.90	37.90
N	99215	FP	41.90	41.90
N	99215	FP SB	NA	16.40
N	99215	FP 52	37.90	37.90
N	99395	FP	79.70	79.70
N	99395	FP SB	NA	31.50
N	99395	FP 22	83.70	83.70
J0696	FP	12.97	12.97
J1055	FP	53.97	53.97
J1056	FP	22.60	22.60
J7300	FP	396.64	396.64
J7302	FP	450.88	450.88
J7303	FP	40.02	40.02
J7304	FP	15.72	15.72
J7307	FP	620.08	620.08
Q0111	FP	2.40	2.40
Y7633	FP	95.00	95.00
Y7634	FP	47.50	47.50
Z4333	FP	19.94	19.94
Z4334	FP	15.09	15.09

(d) Laboratory services (See N.J.A.C. 10:61-3).

(e) Minor surgery:

* An asterisk preceding any procedure code may also be performed by a podiatrist.

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
N	10040	10	18.00	16.00	3
*	10060	10	13.00	11.00	3
*	10061	10	48.00	42.00	3
10080	10	30.00	26.00	3
*	10120	10	18.00	16.00	3
*	10121	10	34.00	29.00	3
*	10140	18.00	16.00	3
*	10160	13.00	11.00	3
*	11000	13.00	11.00	3
*	11001	6.00	5.00	3
*	11040	13.00	11.00	3
*	11041	13.00	11.00	3
*	11042	16.00	14.00	3
*	11043	16.00	14.00	3
*	11100	13.00	11.00	3
*	11400	10	18.00	16.00	3
*	11401	10	22.00	20.00	3
*	11402	10	27.00	24.00	3
*	11403	10	32.00	27.00	3
*	11404	10	32.00	27.00	3
*	11406	10	32.00	27.00	3
*	11420	10	18.00	16.00	3
*	11421	10	22.00	20.00	3
*	11422	10	27.00	24.00	3
*	11423	10	32.00	27.00	3
*	11424	10	32.00	27.00	3
*	11426	10	32.00	27.00	3
11440	10	18.00	16.00	5
11441	10	22.00	20.00	5
11442	10	27.00	24.00	5
11443	10	32.00	27.00	5
11444	10	32.00	27.00	5
11446	10	32.00	27.00	5
*	11600	10	37.00	32.00	3
*	11601	10	47.00	42.00	3
*	11602	10	61.00	53.00	3
*	11620	10	61.00	53.00	3
*	11621	10	90.00	79.00	3
*	11622	10	121.00	105.00	3
11640	10	90.00	79.00	5
11641	10	121.00	105.00	5
11642	10	150.00	131.00	5
*	11730	10.00	10.00	3
*	11750	10	42.00	37.00	3
*	12001	10	18.00	16.00	3
*	12002	10	24.00	21.00	3
*	12004	10	30.00	26.00	3
12005	10	46.00	39.00	3
12006	10	57.00	48.00	3
12007	10	82.50	70.00	3
12011	10	18.00	16.00	5
12013	10	24.00	21.00	5
12014	10	30.00	26.00	5
12031	10	30.00	26.00	3
12032	10	48.00	42.00	3
*	12041	10	30.00	26.00	3
*	12042	10	67.00	59.00	4
12051	10	38.00	33.00	4
12052	10	67.00	59.00	4
13100	10	34.00	29.00	4
13101	10	68.00	63.00	4
13120	10	48.00	42.00	4
13121	10	106.00	92.00	4
*	13131	10	67.00	59.00	4
*	13132	10	145.00	126.00	4
13150	10	38.00	33.00	4
13151	10	82.00	71.00	4
13152	10	193.00	168.00	4
*	17000	10	16.00	14.00	3
*	17110	10	16.00	14.00	3
20526	13.00	11.00	3
*	20550	13.00	11.00	5
*	20551	13.00	11.00	3
*	20552	13.00	11.00	3
*	20553	13.00	11.00	3

(f) Mental health services:

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
N	90801	UC	45.00	45.00
90804	UC	13.00	13.00
90805	UC	13.00	13.00
90806	UC	26.00	26.00
90807	UC	26.00	26.00
N	90847	UC 22	32.00	32.00
N	90853	UC	8.00	8.00
90862	UC	9.00	9.00
N	90887	UC	13.00	13.00
96101	UC	30.00	30.00
96102	UC	18.88	18.88
96103	UC	17.26	17.26
96105	UC	25.00	25.00
N	96150	UC	14.00	14.00
N	96151	UC	14.00	14.00
N	96152	UC	13.00	13.00
N	96153	UC	5.00	5.00
N	96154	UC	13.00	13.00
N	96155	UC	12.00	12.00
L	20100	22.50	22.50
L	Z0170	14.55	14.55

(g) Obstetrical services (maternity):

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
51798	16.00	13.00
59000	37.00	32.00	4
59001	47.00	40.00	4
N	59400	60	468.00	403.00	4
N	59400	SB	60	NA	328.00	4
59409	60	300.00	254.00	5
59409	SB	60	NA	210.00	5
N	59410	60	320.00	272.00	4
N	59410	SB	60	NA	224.00	4
59425	16.00	14.00
59425	SA	NA	13.30
59425	SB	NA	11.20
59426	16.00	14.00
59426	SA	NA	13.30
59426	SB	NA	11.20
N	59430	0	20.00	18.00	0
N	59430	SB	0	NA	14.00	0
59610	45	468.00	403.00	5
59610	SB	45	NA	328.00	5
59612	45	300.00	254.00	5
59612	SB	45	NA	210.00	5
59614	45	320.00	272.00	5
59614	SB	45	NA	224.00	5
59812	45	105.00	91.00	3

(h) Podiatry services:

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
29580	18.00	16.00	3
N	99211	16.00	14.00
N	99212	23.50	20.60
N	99213	23.50	20.60
N	99214	23.50	20.60
N	99215	23.50	20.60

NOTE: See N.J.A.C. 10:66-6.2(f), Surgery, for additional procedures.

(i) Radiology services:

Click here to view table.

(j) Rehabilitation services:

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
N	92507	7.00	7.00
N	92552	11.00	11.00
N	92553	14.00	14.00
N	92557	19.00	19.00
92562	3.00	3.00
92563	3.00	3.00
92564	4.00	4.00
N	92567	5.00	5.00
N	92568	5.00	5.00
N	92572	3.50	3.50
N	92576	19.50	16.50
N	92582	14.00	14.00
92585	45.00	42.00
92590	40.00	34.00
92591	40.00	34.00
92620	34.15	29.03
92621	8.47	7.20
92625	33.94	28.84
97001	7.00	7.00
97002	7.00	7.00
97003	7.00	7.00
97004	7.00	7.00
N	97535	7.00	7.00
N	97799	7.00	7.00
Z0310	45.00	45.00

(k) Vision care services (See N.J.A.C. 10:62-4).

(l) Transportation services:

Follow	Anes.
HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
LN	A0425	UC	2.50	2.50
*N	36415	1.80	1.80
N	67221	90	283.00	241.00
N	67225	23.00	20.00
90746	65.25	65.25
93000	16.00	16.00
93005	11.00	11.00
93010	5.00	5.00
93012	11.00	9.00
93014	5.00	4.25
93015	80.00	68.00
93016	10.00	10.00
93017	35.00	35.00
93018	13.51	11.49
93268	32.00	27.00
93268	TC	19.00	19.00
93268	26	13.00	11.00
93270	17.00	14.00
93271	35.00	30.00
93272	20.00	17.00
96372	2.50	2.50
96373	9.47	8.05
96374	32.22	27.39
96401	36.09	30.68
96402	22.34	18.99
96405	16.00	14.00
96406	20.00	17.00
96409	66.57	56.58
96411	37.94	32.24
96413	90.24	76.70
96415	19.96	16.96
96416	98.05	83.34
96417	44.34	37.69
96420	16.00	14.00
96422	32.00	28.00
96423	16.00	14.00
96425	16.00	14.00
96440	38.00	32.00
96445	38.00	32.00
96450	61.00	52.00
96521	78.82	67.00
96522	62.77	53.35
96542	61.00	52.00
99173	5.00	5.00
N	99201	23.50	20.60
N	99201	SA	NA	19.60
N	99201	SB	NA	16.50
N	99202	23.50	20.60
N	99202	SA	NA	19.60
N	99202	SB	NA	16.50
N	99203	32.30	25.00
N	99203	SA	NA	23.80
N	99203	SB	NA	22.60
N	99203	UD	32.30	25.00
N	*99204	32.30	25.00
N	99204	SA	NA	23.80
N	99204	SB	NA	22.60
N	*99205	32.30	25.00
N	99211	16.00	14.00
N	99211	SA	NA	13.30
N	99211	SB	NA	11.20
N	99212	23.50	20.60
N	99212	SA	NA	19.60
N	99212	SB	NA	16.50
N	*99213	23.50	20.60
N	99213	SA	NA	19.60
N	99213	SB	NA	16.50
N	99213	UD	23.50	20.60
N	*99214	23.50	20.60
N	99214	SA	NA	19.60
N	99214	SB	NA	16.50
N	99215	23.50	20.60
99215	SA	NA	19.60
N	99215	SB	NA	16.50
99217	23.50	20.60
99221	32.30	25.00
99221	SA	NA	23.80
99221	SB	NA	22.60
99222	32.30	25.00
99223	32.30	25.00
99231	23.50	20.60
99231	SA	NA	19.60
99231	SB	NA	16.50
99232	23.50	20.60
99232	SA	NA	19.60
99232	SB	NA	16.50
99233	23.50	20.60
99234	55.90	47.00
99235	55.90	47.00
99236	55.90	47.00
99238	23.50	20.60
99239	23.50	20.60
N	99241	44.00	37.00
N	99242	64.70	54.40
N	99243	64.70	54.40
N	99244	91.10	77.90
99244	SM	73.50	62.50
99244	SN	73.50	62.50
N	99245	91.10	77.90
N	99251	34.50	29.30
N	99252	64.70	54.40
N	99253	64.70	54.40
N	99254	91.10	77.90
N	99255	91.10	77.90
99261	16.00	14.00
99262	23.50	20.60
99263	23.50	20.60
99281	16.00	14.00
99281	SA	NA	13.30
99282	23.50	20.60
99282	SA	NA	19.60
99283	23.50	20.60
99283	SA	NA	19.60
99284	32.30	25.00
99284	SA	NA	23.80
99285	32.30	25.00
N	99291	66.20	58.80
N	99292	33.10	29.40
N	99354	66.20	58.80
N	99354	SA	NA	55.90
N	99355	33.10	29.40
N	99355	SA	NA	27.90
99356	66.20	58.80
99357	33.10	29.40
99381	80.06	68.05
99381	22	80.06	68.05
99381	SA	NA	64.65
99381	EP SA	NA	64.65
99381	22 EP	80.06	68.05
99381	22 SA	NA	64.65
99382	86.53	73.55
99382	EP	86.53	73.55
99382	EP SA	NA	69.87
99382	22 EP	86.53	73.55
99382	SA	NA	69.87
99382	SA 52	NA	69.87
99382	22	86.53	73.55
99382	22 SA	NA	69.87
*99383	85.17	72.39
99383	EP	85.17	72.39
99383	SA	NA	68.77
99383	SA 52	NA	68.77
*99384	92.67	78.77
99384	EP	92.67	78.77
99384	SA	NA	74.83
99384	SA 52	NA	74.83
99384	SB	NA	64.87
*99385	32.30	25.00
99385	EP	92.67	78.77
99385	SA	NA	23.80
99385	SA 52	NA	23.80
99385	SB	NA	22.60
*99386	32.30	25.00
99386	SA	NA	23.80
99386	SB	NA	22.60
*99387	32.30	25.00
99387	SA	NA	23.80
99387	SB	NA	22.60
99391	64.05	54.44
99391	SA	NA	51.72
99391	EP	64.05	54.44
99391	22	64.05	54.44
99391	EP SA	NA	51.72
99391	22 EP	64.05	54.44
99392	71.54	60.81
99392	EP	71.54	60.81
99392	22	71.54	60.81
99392	SA	NA	51.72
99392	22 SA	NA	51.72
99392	EP SA	NA	51.72
99392	22 EP	71.54	60.81
99392	SA 52	NA	51.72
*99393	70.86	60.23
99393	SA	NA	57.22
99393	EP	70.86	60.23
99393	SA 52	NA	57.22
*99394	77.68	66.03
99394	EP	77.68	66.03
99394	SA	NA	62.73
99394	SA 52	NA	62.73
99394	SB	NA	54.38
*99395	32.30	25.00
99395	EP	78.36	66.61
99395	SA	NA	23.80
99395	SA 52	NA	23.80
99395	SB	NA	22.60
99396	32.30	25.00
99396	SA	NA	23.80
99396	SB	NA	22.60
*99397	32.30	25.00
99397	SA	NA	23.80
99397	SB	NA	22.60
99460	51.37	43.66
99460	SA	NA	41.48
99461	73.46	62.44
99463	69.22	58.83
99463	SA	NA	55.89
99464	65.14	55.37
99465	127.74	108.58

(m) Substance use disorder treatment facility services:

Follow	Anes.
HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
11975	FP	30	B.R.	B.R.
N	11975	22	30	B.R.	B.R.
11976	FP	90	190.00	190.00
N	11977	22	90	B.R.	B.R.
11981	FP	100.00	100.00
11982	FP	100.00	100.00
11983	FP	180.00	180.00
36415	FP	3.40	3.40
36416	FP	1.80	1.80
54056	FP	32.00	32.00	3
N	55250	30	90.00	79.00	3
N	55450	30	42.00	37.00	3
56501	FP	29.00	29.00	3
56820	FP	30	88.00	NA
56821	FP	30	113.00	NA
57420	FP	71.00	NA	3
57421	FP	15	93.00	NA	3
57452	FP	39.90	39.90	3
57454	FP	64.60	64.60	3
57511	FP	45	45.60	45.60	3
58300	FP	30	74.10	74.10	3
58300	SA FP	30	NA	29.85	3
58300	SB FP	30	NA	29.85	3
58301	16.40	16.40
58301	FP	31.20	31.20
58301	SA FP	NA	16.40	3
58301	SB FP	NA	16.40
81000	FP	1.20	1.20
81002	FP	1.00	1.00
81025	FP	3.00	3.00
82465	FP	3.00	3.00
82947	FP	4.34	4.34
82948	FP	1.50	1.50
85013	FP	1.50	1.50
85018	FP	2.00	2.00
86592	FP	1.50	1.50
86701	FP	12.00	12.00
86762	FP	12.00	12.00
87086	FP	6.00	6.00
87184	FP	9.00	9.00
87270	FP	10.00	10.00
87274	FP	12.80	12.80
87320	FP	12.50	12.50
87490	FP	20.00	20.00
87491	FP	38.00	38.00
87590	FP	25.00	25.00
87591	FP	38.00	38.00
87620	FP	25.00	25.00
87621	FP	38.00	38.00
88141	FP	6.00	6.00
88142	FP	18.00	18.00
88143	FP	18.00	18.00
88148	FP	13.48	13.48
88150	FP	6.00	6.00
88151	6.00	6.00
88152	FP	6.00	6.00
88153	FP	6.00	6.00
88154	FP	6.00	6.00
88164	FP	6.00	6.00
88165	FP	6.00	6.00
88166	FP	6.00	6.00
88167	FP	6.00	6.00
88305	FP	40.00	40.00
90471	FP	16.18	16.18
90649	FP	153.25	153.25
90671	FP	16.18	16.18
96372	FP	4.80	4.80
N	99201	FP	83.70	83.70
N	99201	FP SB	NA	31.50
N	99201	FP 52	79.70	79.70
N	99202	FP	83.70	83.70
N	99202	FP SB	NA	31.50
N	99202	FP 52	79.70	79.70
N	99203	FP	83.70	83.70
N	99203	FP SB	NA	31.50
N	99203	FP 52	79.70	79.70
N	99204	FP	83.70	83.70
N	99204	FP SB	NA	31.50
N	99204	FP 52	79.70	79.70
N	99205	FP	83.70	83.70
N	99205	FP SB	NA	31.50
N	99205	FP 52	79.70	79.70
N	99211	FP	41.90	41.90
N	99211	FP SB	NA	16.40
N	99211	FP 52	37.90	37.90
N	99212	FP	41.90	41.90
N	99212	FP SB	NA	16.40
N	99212	FP 52	37.90	37.90
N	99213	FP	41.90	41.90
N	99213	FP SB	NA	16.40
N	99213	FP 52	37.90	37.90
N	99214	FP	41.90	41.90
N	99214	FP SB	NA	16.40
N	99214	FP 52	37.90	37.90
N	99215	FP	41.90	41.90
N	99215	FP SB	NA	16.40
N	99215	FP 52	37.90	37.90
N	99395	FP	79.70	79.70
N	99395	FP SB	NA	31.50
N	99395	FP 22	83.70	83.70
J0696	FP	12.97	12.97
J1055	FP	53.97	53.97
J1056	FP	22.60	22.60
J7300	FP	396.64	396.64
J7302	FP	450.88	450.88
J7303	FP	40.02	40.02
J7304	FP	15.72	15.72
J7307	FP	620.08	620.08
Q0111	FP	2.40	2.40
Y7633	FP	95.00	95.00
Y7634	FP	47.50	47.50
Z4333	FP	19.94	19.94
Z4334	FP	15.09	15.09

(n) Federally qualified health care services:

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
L	W9840	contract	contract
W9843	contract	contract
L	D0120	22	contract	contract
T1015	contract	contract
T1015	EP	contract	contract
T1015	HD	contract	contract
L	T1015	HE	contract	contract

(o) Personal care assistant services:

Follow	Maximum Fee			Anes.

HCPCS	Up	Allowance			Basic

Ind	Code	Mod	Days	S	$	NS	Units
L	Z1600	UC	13.02	13.02
L	Z1605	UC	10.23	10.23
L	Z1610	UC	35.00	35.00
L	Z1611	UC	6.51	6.51
L	Z1612	UC	5.12	5.12
L	Z1613	UC	35.00	35.00

(p) Vaccine for Children Program Administration Codes:

Ind	HCPCS Code	Maximum Fee Allowance
N	90465	16.18
N	90466	11.50
N	90467	11.44
N	90468	8.77
N	90471	16.18
N	90472	11.50
N	90473	12.12
N	90474	8.43

(q) Immunizations

HCPCS
Ind	Code	Maximum Fee Allowance
N	++	90632	80.95
N	++	90632	80.95
++	90633	38.24
N	90636	103.04
++	90647	31.52
++	90648	29.54
N	90649	153.25
++	90655	19.33
++	90656	20.64
++	90657	9.41
++	90658	17.56
++	90660	25.69
90665	B.R.
++	90669	94.62
90675	B.R.
++	90680	88.64
90681	130.44
90691	79.90
++	90696	61.75
++	90698	92.70
++	90700	28.68
90702	31.56
90703	17.72
90704	29.08
90705	24.21
90706	25.37
++	90707	56.96
++	90713	33.03
++	90714	26.05
++	90715	47.25
++	90716	98.27
90717	81.35
++	90718	17.50
++	90721	55.35
++	90723	90.90
N	++	90732	35.76
90733	115.18
N	++	90734	114.10
90736	188.66
90740	209.86
++	90743	74.28
++	90744	29.62
N	++	90746	65.25
N	++	90748	56.20
90749	B.R.

"++" Indicates that this vaccine is covered under the VFC Program. Providers must report both the appropriate VFC administration code and the associated HCPCS procedure code when requesting payment for the administration fee(s) for VFC vaccines to ensure appropriate reimbursement is provided. (See N.J.A.C. 10:66-2.20.)

(r) Miscellaneous services:

Follow				Anes.

HCPCS	Up	Maximum Fee			Basic
Allowance
Ind	Code	Mod	Days	S	$	NS	Units
58120	15	72.00	63.00	3
N	59840	45	79.00	68.00	3
N	59841	45	79.00	68.00	3

New Jersey Administrative CodeTitle 10 - HUMAN SERVICESChapter 66 - INDEPENDENT CLINIC SERVICESSubchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)Section 10:66-6.2 - HCPCS procedure code numbers and maximum fee allowance schedule

New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 66 - INDEPENDENT CLINIC SERVICES
Subchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:66-6.2 - HCPCS procedure code numbers and maximum fee allowance schedule