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
|"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|
|"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)|
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
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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