New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 68 - CHIROPRACTIC SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:68-1.5 - Basis of reimbursement
Universal Citation: NJ Admin Code 10:68-1.5
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Reimbursement for covered chiropractic services provided to a Medicaid/NJ FamilyCare beneficiary is provided on the basis of the customary charge (fee-for-service) not to exceed an allowance determined reasonable by the Commissioner of the New Jersey State Department of Human Services and contained at N.J.A.C. 10:68-3.2.
1. In no event shall the charge to the New
Jersey Medicaid/NJ FamilyCare program exceed the charge by the provider for
identical services to other governmental agencies, or other groups or
individuals in the community.
2.
The chiropractor may be reimbursed for an initial diagnostic and/or evaluation
visit in the absence of manipulation of the spine performed during that
visit.
3. The procedure codes that
are used when submitting claims are listed at
N.J.A.C.
10:68-3.2, Centers for Medicare &
Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS). The
Fiscal Agent Billing Supplement, incorporated herein by reference, provides
information about the claim form and billing instructions. Claims for services
rendered shall be submitted by providers in accordance with the Fiscal Agent
Billing Supplement. Instructions on how to obtain a copy of the Fiscal Agent
Billing Supplement can be found at N.J.A.C. 10:68 Appendix A.
(b) Reimbursement shall not be made for broken appointments, nor shall the provider ask the beneficiary to pay for broken appointments.
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