New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 67 - PSYCHOLOGICAL SERVICES
Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE AND MAXIMUM FEE SCHEDULE FOR PSYCHOLOGICAL SERVICES
Section 10:67-3.1 - Introduction
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The New Jersey Medicaid and NJ FamilyCare programs adopted the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d et seq., and incorporated herein by reference, as amended and supplemented and published by PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010. Revisions to the Healthcare Common Procedure Coding System made by CMS (code additions, code deletions and replacement codes) will be reflected in this chapter through publication of a notice of administrative change in the New Jersey Register. Revisions to existing reimbursement amounts specified by the Department and specification of new reimbursement amounts for new codes will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.SA. 52:14B-1 et seq. The HCPCS Level I codes consist of the American Medical Association (AMA) Current Procedural Terminology (CPT) codes, which are assigned to specific procedures by the AMA. HCPCS Level II codes are assigned to specific procedures by CMS. An updated copy of the CPT codes may be obtained from the American Medical Association, P.O. Box 10950, Chicago, IL 60610, or by accessing www.ama-assn.org. An updated copy of the Level II codes may be obtained by accessing the HCPCS website at www.cms.hhs.gov/medicare/hcpcs or by contacting PMIC, 4727 Wilshire Blvd., Suite 300, Los Angeles, CA 90010.
(b) When submitting a claim, the psychologist must always use his or her usual and customary fee. The MAXIMUM FEE ALLOWANCE designated for any HCPCS code represents the New Jersey Medicaid/NJ FamilyCare program's maximum payment for the given procedure.
(c) The psychological services use exclusively Level I HCPCS codes of a two-level coding system, as follows:
(d) Specific elements of HCPCS codes require the attention of providers. The lists of HCPCS code numbers for psychologist services are arranged in tabular form with specific information for a code given under columns with titles such as: "IND," "HCPCS CODE," "MOD," "DESCRIPTION," "FOLLOW-UP DAYS," and "MAXIMUM FEE ALLOWANCE." The information given under each column is summarized below:
IND | lists alphabetic symbols used to refer the provider to information concerning the New Jersey Medicaid/NJ FamilyCare program's qualifications and requirements when a procedure or service code is used. An explanation of the indicators and qualifiers used in this column is located below and in paragraph 1, "Alphabetic and numeric symbols," as follows: |
"P" = | preceding any procedure code indicates that prior |
authorization shall be required. The appropriate form | |
that must be used to request prior authorization is | |
indicated in the Fiscal Agent Billing Supplement. | |
"N" = | preceding any procedure code means that qualifiers are |
applicable to that code. (See also 10:67-2.3 | |
for the specific limitations of the total dollar | |
amounts for services within a specific timeframe for a | |
specific Medicaid/NJ FamilyCare beneficiary.) | |
HCPCS CODE = | HCPCS procedure code numbers. |
MOD = | Alphabetic and numeric symbols: Under certain |
circumstances, services and procedures may be modified | |
by the addition of alphabetic and/or numeric | |
characters at the end of the code. | |
22" = | "Unusual Services: When the service(s) provided is |
greater than that usually required for the listed | |
procedure, it may be identified by adding the modifier | |
"22" to the usual procedure number. A report with | |
additional documentation must accompany the claim form | |
to justify the greater services, unusual services or | |
complications. | |
HA = | Services provided in child and/or adolescent treatment program. |
(e) Listed below are general policies of the New Jersey Medicaid/NJ FamilyCare program that pertain to HCPCS. Specific information concerning the responsibilities of a psychologist when rendering Medicaid/NJ FamilyCare-covered services and requesting reimbursement are located at 10:67-1.4, Recordkeeping; 10:67-1.5, Basis of reimbursement; and N.J.A.C. 10:67-2, General provisions.