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 10:77-7.2 - HCPCS procedure code numbers and maximum fee allowance schedule
Universal Citation: NJ Admin Code 10:77-7.2
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Environmental Lead Inspection Codes:
| HCPCS Code | Description | Maximum Fee Allowance |
|---|---|---|
| Y 9733 | Initial Inspection for Lead | $ 260.00 |
| Y 9734 | Reinspection for Lead | 100.00 |
| Qualifier: Limit of two reinspections per | ||
| primary residence per family | ||
(b) Mental Health Rehabilitation Services provided in psychiatric community residences for youth, group homes, or residential childcare facilities:
| IND | HCPCS Code | MOD | Procedure Code Definition | Maximum Fee Allowance |
| P | H0018 | TJ | Mobile Response-Crisis Bed. For services rendered in psychiatric community residences for youth, group homes or residential childcare facilities to a child, youth or young adult receiving mobile response and stabilization management services (per diem, not to exceed seven days) | $ 50.00 per diem |
| Y9933 | Mental health rehabilitation services provided in non-JCAHO accredited residential treatment centers licensed as community psychiatric residences for youth licensed by the Division of Mental Health and Addiction Services, under N.J.A.C. 10:128 | Contract pricing | ||
| Y9934 | Mental health rehabilitation services provided in therapeutic foster care facilities, licensed by the Division of Child Protection and Permanency, that contract with the Division of Mental Health and Addiction Services under N.J.A.C. 10:128. | Contract pricing | ||
| Y9935 | Mental health rehabilitation services provided in group homes (serving six to 12 children) licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. | Contract pricing | ||
| Y9936 | Mental health rehabilitation services provided in supervised transitional living homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. | Contract pricing | ||
| Y9937 | Mental health rehabilitation services provided in teaching family homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. | Contract pricing | ||
| Y9938 | Mental health rehabilitation services provided in treatment homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. | Contract Pricing | ||
| Y9939 | Mental health rehabilitation services provided in alternative care homes licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:128. | Contract pricing | ||
| Y9943 | Mental health rehabilitation services provided in non-JCAHO residential child care facilities licensed by the Division of Child Protection and Permanency, under N.J.A.C. 10:127. | Contract pricing | ||
| Y9944 | Room and board for mental health rehabilitation services provided in facilities under contract with the Division of Child Protection and Permanency, under N.J.A.C. 10:127 and 10:128. | Contract pricing | ||
| Y9945 | Room and board for mental health rehabilitation services provided in facilities under contract with the Division of Mental Health and Addiction Services, under N.J.A.C. 10:128. | Contract pricing | ||
| Y9946 | All other room and board for mental health rehabilitation services. | Contract pricing | ||
| Y9947 | Mental health rehabilitation services provided in JCAHO accredited RTCs licensed by the Division of Mental Health and Addiction Services (DMHAS), under N.J.A.C. 10:128. | Contract pricing | ||
| Y9948 | Mental health rehabilitation services provided in JCAHO accredited RTCs licensed by the Division of Child Protection and Permanency (DCP&P), under N.J.A.C. 10:127. | Contract pricing | ||
| Y9992 | Therapeutic Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DMHAS | Contract pricing | ||
| Y9993 | Therapeutic Leave for Room and Board Board Services provided in non-JCAHO accredited facilities under contract with DMHAS | Contract pricing | ||
| Y9994 | Hospital Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DMHAS | Contract pricing | ||
| Y9995 | Hospital Leave for Room and Board Services provided in non-JCAHO accredited facilities under contract with DMHAS | Contract pricing | ||
| Y9996 | Therapeutic Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DCP&P | Contract pricing | ||
| Y9997 | Therapeutic Leave for Room and Board Board Services provided in non-JCAHO accredited facilities under contract with DCP&P | Contract pricing | ||
| Y9998 | Hospital Leave for Rehabilitation Services provided in non-JCAHO accredited facilities under contract with DCP&P | Contract pricing | ||
| Y9999 | Hospital Leave for Room and Board Services provided in non-JCAHO accredited facilities under contract with DCP&P | Contract pricing |
(c) Behavioral Assistance Services Codes:
| IND | HCPCS Code | MOD | Procedure Code Definition | Maximum Fee Allowance |
| P | H2014 | TJ | Individual behavioral assistance services. (15-minute unit of service) | $18.19/unit |
| P | H2014 | TJ UN | Group behavioral assistance services. Services are limited to those provided directly to, or in support of, two children/youth or young adults. (15-minute unit of service) | $11.10/unit per child |
| P | H2014 | TJ UP | Group behavioral assistance services. Services are limited to those provided directly to or in support of three children/youth or young adults. (15-minute unit of service) | $30.83/unit per child |
| P | S5125 | TJ | Individual behavioral assistance services in non-Title XIX eligible locations. (15-minute unit of service) | $ 9.75 ($ 39.00 per hour) |
| P | S5125 | TJ UN | Small group behavioral assistance services in non-Title XIX eligible locations. Services are limited to those provided directly or in support of two children/youth or young adults. (15-minute unit of service) | $ 5.62/unit per child |
| P | S5125 | TJ UP | Small group behavioral assistance services in non-Title XIX eligible locations. Services are limited to those provided directly or in support of three children/youth or young adults. (15-minute unit of service) | $ 4.25/unit per child |
(d) Mobile response and stabilization management services codes:
| IND | HCPCS Code | MOD | Procedure Code Definition | Maximum Fee Allowance |
| P | S9485 | TJ | Mobile Response-Initial (one unit of service per episode, not to exceed 72 hours, spanning up to four days) | $1,320 per unit of service |
| P | H0032 | TJ | Mobile Response-Care Coordination and Stabilization Plan (15 minute units of service, not to exceed a total of 64 units or 16 hours, up to eight weeks as authorized weekly) | $8.40 per unit of service |
(e) Intensive in-community mental health rehabilitation services:
| IND | HCPCS Code | MOD 1&2 | Procedure Code Definition | Maximum Fee Allowance |
| P | H0036 | TJ U3 | Supportive service level (intensive in-community services delivered by, at a minimum, a bachelor's level direct care provider) Individual, 15 minute units of service | $ 18.25 per unit of service. ($ 73.00 per hour) |
| P | H0036 | TJ U2 | Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Individual, 15-minute unit of service | $28.74 per unit of service. ($114.96 per hour) |
| P | H0036 | TJ HQ | Professional service level (intensive in-community services delivered by, at a minimum, a master's level direct care provider) Group, 15 minute units of service | Contract Pricing |
| P | H0036 | TJ U1 | Clinical level services(intensive in-community services delivered by a licensed behavioral health care practitioner) Individual, 15-minute unit of service | $30.83 per unit of service ($123.32 per hour) |
| P | H0036 | U1 UN | Clinical level services (intensive in-community services delivered by a licensed behavioral healthcare practitioner) Group services provided directly to, or in support of, two children, youth or young adults, 15-minute unit of service. | $20.17/unit per child |
| P | H0036 | U2 UN | Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Group services provided directly to, or in support of, two children, youth, or young adults, 15-minute unit of service | $18.45/unit per child |
| P | H0036 | U1 UP | Clinical level services (intensive in-community services delivered by a licensed behavioral healthcare practitioner) Group services provided directly to, or in support of, three children, youth, or young adults, 15-minute unit of service. | $17.45/unit per child |
| P | H0036 | U2 UP | Professional service level (intensive incommunity services delivered by, at a minimum, a master's level direct care provider) Group services provided directly to, or in support of, three children, youth, or young adults, 15-minute unit of services | $15.02/unit per child |
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
