New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN
Subchapter 7 - CENTERS FOR MEDICARE & MEDICAID SERVICES' HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:77-7.1 - Introduction
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The New Jersey Medicaid NJ FamilyCare programs utilize the Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS). HCPCS follows the American Medical Association's Physicians' Current Procedural Terminology (CPT) architecture, employing a five-position code and as many as two 2-position modifiers. CPT is a listing of descriptive terms and numeric identifying codes and modifiers for reporting medical procedures and services performed by physicians. Unlike the CPT numeric design, the CMS-assigned codes and modifiers contain alphabetic characters. The New Jersey Medicaid/NJ FamilyCare program adopted the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System 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, 52:14B-1 et seq. The HCPCS codes as listed in this subchapter are relevant to Medicaid and NJ FamilyCare fee-for-services rehabilitation services for children and must be used when filing a claim. An updated copy of the HCPCS codes may be obtained by accessing www.njmmis.com.
(b) HCPCS is a two-level coding system:
(c) Regarding specific elements of HCPCS codes, which require the attention of providers, the lists of HCPCS code numbers for rehabilitative services are arranged in tabular form with specific information for a code given under columns with titles, such as "IND," "HCPCS Code," "MOD," "DESCRIPTION" and "MAXIMUM FEE ALLOWANCE." The information given under each column is summarized below:
HQ: Services provided in a group setting.
TJ: Program group, child and/or adolescent.
UN: Group services; two patients served.
UP: Group services; three patients served.
U1: Level of care 1 - residential care supervision
U2: Level of care 2 - residential care supervision
U3: Level of care 3 - residential care supervision
(d) Listed below are both general and specific policies of the New Jersey Medicaid/NJ FamilyCare program that pertain to HCPCS: