N.J. Admin. Code § 10:58-3.2 - Elements of HCPCS Procedure Codes which require attention of the certified nurse midwife

Current through Register Vol. 54, No. 7, April 4, 2022

(a) The list of HCPCS procedure codes for nurse midwifery 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," "MAXIMUM FEE ALLOWANCE SCHEDULE" and "ANESTHESIA BASIC UNITS." The information given under each column is summarized below:

Column Title
"IND" (Indicator-Qualifier) Lists alphabetic symbols used to refer
a provider to information concerning the New Jersey Medicaid/
NJ FamilyCare programs' qualifications and requirements when
a HCPCS procedure code is used.
Explanation of indicators and qualifiers used in this column
are given below:
"N" Preceding any procedure code means that qualifiers are
applicable to that code.
"HCPCS CODES"--Lists the HCPCS procedure codes.
"MOD" Lists alphabetic and numeric symbols. Services and procedures
may be modified under certain circumstances. When applicable,
the modifying circumstance is identified by the addition of
alphabetic and/or numeric characters affixed to the code. The
modifiers are as follow:
"SB" Midwifery: Used to identify procedures performed by CNM by
adding the modifier "SB" to the procedure code.
"22" Unusual Services: When the service(s) provided is greater
than that usually required for the listed procedure, it may
be identified by affixing "22" after the usual procedure
number.
"52" Reduced Services: Under certain circumstances, a service or
procedure is partially reduced or eliminated. Under these
circumstances, the service provided can be identified by its
usual procedure number and the addition of the modifier "52",
signifying that the service is reduced. This provides a means
of reporting reduced services without disturbing the
identification of the basic service.
"DESCRIPTION"--Lists the code narrative for Level II and III codes.
Narratives for Level I codes are found in the CPT.
"FOLLOW-UP"--Lists the number of days for follow-up.
"MAXIMUM FEE ALLOWANCE"--Lists the New Jersey Medicaid/NJ FamilyCare
programs' reimbursement schedule for nurse midwifery services.
"ANESTHESIA BASIC UNITS"--B.U.V. (Basic Unit Value)
1. These symbols when listed under the "IND" and "MOD" columns are elements of the HCPCS coding system used as qualifiers or indicators (as in the "IND" column) and as modifiers (as in the "MOD" column). They assist the CNM in determining the appropriate procedure codes to be used, the area to be covered, the minimum requirements needed, and any additional parameters required to be eligible for reimbursement.
i. These symbols and/or letters must not be ignored, because in certain instances there are requirements in addition to the narrative, which accompanies the HCPCS procedure code as described in the CPT. The CNM is responsible for all the requirements and not just the code narrative as described in the CPT. All the described requirements in the CPT must be fulfilled in order to be eligible for reimbursement.

Notes

N.J. Admin. Code § 10:58-3.2
Amended by R.2001 d.204, effective 6/18/2001.
See: 33 N.J.R. 1160(a), 33 N.J.R. 2188(a).
In "IND", substituted "/NJ FamilyCare programs' " for "program's"; in "DESCRIPTION", substituted "CPT" for "CPT-4"; in "MAXIMUM FEE ALLOWANCE", inserted a reference to NJ FamilyCare; in "ANESTHESIA BASIC UNITS", substituted "CPT" for "CPT-4" in 1i.
Amended by R.2006 d.338, effective 9/18/2006.
See: 38 N.J.R. 2003(a), 38 N.J.R. 3900(a).
In (a), substituted table entry "SB" for existing entry "WM".

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