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 10:66-6.3 - HCPCS procedure codes and maximum fee allowance schedule for Level codes and narratives (not located in CPT)

Universal Citation: NJ Admin Code 10:66-6.3

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

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

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

HCPCS	Follow Up	Maximum	Fee	Allowance
Ind	Code	Mod	Description	Days	S	$	NS
Z0100	Off- Site
Crisis
Intervention--An
emergency
procedure by
personnel of
a mental
health
clinic to an
outpatient
individual
at locations
other than
the grounds
or buildings
of the
clinic.	22.50	22.50
Request for
this service
shall be
initiated by
the patient
or other
interested
individual
to meet the
immediate
needs of the
patient, who
is unable to
present
himself at
the clinic.
The
procedure
includes
rapid
intervention,
written
evaluation
land a
treatment
plan. Use of
procedure is
limited to
twice in six
months for
any one
patient.
This
procedure is
not
applicable
to
institutionalized
patients.
Partial
Care: A
mental
health
service
whose
primary
purpose is
to maximize
the client's
independence
land
community
living
skills in
order to
reduce
unnecessary
hospitalization.
It is
directed
toward the
acute and
chronically
disabled
individual.
Partial Care
programs
shall
provide, as
listed
below, a
full system
of services
necessary to
meet the
comprehensive
needs of the
individual
client.
Services
shall be
provided or
arranged
for, to meet
the
individual
needs of
participating
clients.
These
services
shall
include:
Assessment
land
evaluation;
Service
procurement;
Therapy;
Information
land
referral;
Counseling;
Daily
living
education;
Community
organization;
Pre-vocational
therapy;
Recreational
therapy;
and
Health
related
services.
Partial
Care
programs
shall be
available
daily for
five days a
week, with
additional
planned
activities
each week
during
evening
and/or
weekend
hours as
needed.
Individual
clients need
not attend
every day
but as
needed.
Partial
Care
programs
specifically
developed
for children
may be
available
four days a
week, with
one evening
and/or
weekend
activity(ies).
The staff
of the
Partial Care
program
\|\|should
include a
Director who
shall be a
qualified
professional
from the
specialties
of
psychiatry,
psychology,
social work,
psychiatric
nursing,
vocational
rehabilitation,
or a related
field with
training
and/or
experience
in direct
service
provision
and
administration.
a
qualified
psychiatrist
shall be
available to
the Partial
Care program
on a
regularly
scheduled
basis, for
consultation.
Other staff
deemed
necessary to
implement a
Partial Care
program
which meets
the
requirement
of this
section
should
include
qualified
mental
health
professionals,
paraprofessionals
land
volunteers.
In order
to qualify
as an
approved
Partial Care
program the
Program must
be certified
by the
Department.
NOTE:
Except for
transportation
these rates
reflect full
payments
with a
prohibition
against
multiple
billing for
more than
one service
to a
Medicaid
patient in a
given day.

(d) Vision care services. See N.J.A.C. 10:62-3.

(e) Transportation services:

HCPCS	Follow Up	Maximum	Fee	Allowance
Ind	Code	Mod	Description	Days	S	$	NS
A0425	UC	Per trip,	2.50	2.50
one way,
to/from a
Partial Care
program
Z0330	Transportation,	4.50	4.50
one way.

(f) Substance use disorder treatment facility services:

HCPCS	Follow Up	Maximum	Fee	Allowance
Ind	Code	Mod	Description	Days	S	$	NS
Z2000	Family	22.50	22.50
therapy
rendered in
a drug
treatment
center.
Z2001	Family	15.00	15.00
conference
rendered in
a drug
treatment
center.
Z2002	Prescription	4.50	4.50
visit
rendered in
a drug
treatment
center
Z2003	Psychotherapy	16.00	16.00
rendered in
a drug
treatment
center-full
session.
Z2004	Group	8.00	8.00
therapy
rendered in
a drug
treatment
center, per
person.
Z2005	Psychological	15.00	15.00
testing
rendered in
a drug
treatment
center, per
hour;
maximum of
five hours.
Z2006	Methadone	2.50	2.50
treatment
rendered in
a drug
treatment
center.
Z2007	Psychotherapy	8.00	8.00
rendered in
a drug
treatment
center-half
session.
Z2010	Urinalysis	4.50	4.50
for drug
addiction.
Z3348	Family	45.00	45.00
therapy
rendered in
a
narcotic/alcohol
clinic, per
hour
Z3349	Family	35.00	35.00
conference
rendered in
a
narcotic/alcohol
clinic, per
visit
Z3353	Prescription	4.50	4.50
visit
rendered in
a
narcotic/alcohol
clinic, per
visit
Z3354	Psychotherapy	\|45.00	\|45.00
rendered in
a
narcotic/alcohol
clinic, per
hour
Z3355	Group	20.00	20.00
therapy
rendered in
a
narcotic/alcohol
clinic, per
hour
Z3356	Psychological	15.00	15.00
testing
rendered in
a
narcotic/alcohol
clinic, per
hour
Z3357	Methadone	4.00	4.00
treatment
rendered in
a
narcotic/alcohol
clinic, per
visit
Z3358	Psychotherapy	23.00	23.00
half
session
rendered in
a
narcotic/alcohol
clinic, per
half hour
Z3359	Urinalysis	5.20	5.20
rendered in
a
narcotic/alcohol
clinic

(g) Federally qualified health center services:

HCPCS	Follow Up	Maximum	Fee	Allowance
Ind	Code	Mod	Description	Days	S	$	NS
W9840	Medical	contract	contract
encounter
W9843	EPSDT	contract	contract
encounter
D0120	22	Dental	contract	contract
encounter
T015	HD	OB/GYN	contract	contract
Encounter
T015	HE	Mental	contract	contract
health
encounter

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