N.J. Admin. Code § 10:77-7.2 - HCPCS procedure code numbers and maximum fee allowance schedule

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

(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:
Maximum
HCPCS Fee
IND Code MOD Procedure Code Definition Allowance
P H2014 TJ Individual behavioral assistance $ 9.75
services. (15-minute unit of service) ($ 39.00
per hour)
P H2014 TJ UN Group behavioral assistance $ 5.62/unit
services. Services are limited to per child
those provided directly to, or in
support of, two children/youth or
young adults. (15-minute unit of
service)
P H2014 TJ UP Group behavioral assistance $ 4.25/unit
services. Services are limited to per child
those provided directly to or in
support of three children/youth or
young adults. (15-minute unit of
service)
P S5125 TJ Individual behavioral assistance $ 9.75
services in non-Title XIX eligible ($ 39.00
locations. (15-minute unit of per hour)
service)
P S5125 TJ UN Small group behavioral assistance $ 5.62/unit
services in non-Title XIX eligible per child
locations. Services are limited to
those provided directly or in
support of two children/youth or
young adults. (15-minute unit of
service)
P S5125 TJ UP Small group behavioral assistance $ 4.25/unit
services in non-Title XIX eligible per child
locations. Services are limited to
those provided directly or in
support of three children/youth or
young adults. (15-minute unit of
service)
(d) Mobile response and stabilization management services codes:
Maximum
HCPCS Fee
IND Code MOD Procedure Code Definition Allowance
P S9485 TJ Mobile Response--Initial (one unit $ 1,307 per
of service per episode, not to unit of
exceed 72 hours, spanning up to service
four days)
P H0032 TJ Mobile Response--Care $ 8.32 per
Coordination and Stabilization Plan unit of
(15 minute units of service, not to service
exceed a total of 64 units or 16
hours, up to eight weeks as
authorized weekly)
(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 $ 18.25 per unit of
(intensive in-community service. ($ 73.00
services delivered by, at a per hour)
minimum, a bachelor's level
direct care provider)
Individual, 15 minute units of
service
P H0036 TJ HQ Supportive service level Contract Pricing
(intensive in-community
services delivered by, at a
minimum, a bachelor's level
direct care provider) Group, 15
minute units of service
P H0036 TJ U2 Professional service level $ 21.25 per unit of
(intensive in-community service. ($ 85.00
services delivered by, at a per hour)
minimum, a master's level
direct care provider)
Individual, 15 minute units of
service
P H0036 TJ HQ Professional service level Contract Pricing
(intensive in-community
services delivered by, at a
minimum, a master's level
direct care provider) Group, 15
minute units of service
P H0036 TJ U1 Clinical level services $ 28.25 per unit of
(intensive in-community service. ($ 113.00
services delivered by a per hour)
licensed behavioral health care
practitioner) Individual, 15
minute units of service
P H0036 U1 UN Clinical level services $ 19.00/unit per
(intensive in-community child
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
units of service.
P H0036 U1 UP Clinical level services $ 15.91/unit per
(intensive in-community child
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 units of service.

Notes

N.J. Admin. Code § 10:77-7.2
Amended by 48 N.J.R. 81(a), effective 1/4/2016

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