New Jersey Administrative Code

(a) Evaluation and management and other procedures * An asterisk preceding any procedure code may also be performed in a substance use disorder treatment facility. Follow Anes. HCPCS Up Maximum Fee Basic Allowance Ind Code Mod Days S $ NS Units *N 36415 1.80 1.80 N 67221 90 283.0…

(a) Dental services (See N.J.A.C. 10:56-3). (b) Laboratory services (See N.J.A.C. 10:61-3). (c) Mental health services: HCPCS Follow Up Maximum Fee Allowance Ind Code Mod Description Days S $ NS Z0100 Off- Site Crisis Intervention--An emergency procedure by personnel of a mental …

(a) Evaluation and management and other procedures:1. Drawing of blood: 36415. i. Once per visit, per patient. (Not applicable if laboratory study, in any part, is performed by the clinic.) 2. Photodynamic therapy: 67221 for one eye and 67225 for the second eye at single session.…

(a) HealthStart Maternity Care code requirements are as follows: 1. Separate reimbursement shall be available for Maternity Medical Care Services and Maternity Health Support Services. 2. Maternity Medical Care Services shall be billed as a total obstetrical package when feasible…

(a) This chapter outlines the policies and the procedures of the New Jersey Medicaid/NJ FamilyCare program related to the provision of psychological services to Medicaid/NJ FamilyCare beneficiaries by psychologists in private practice reimbursed on a fee-for-service basis. (b) Th…

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise. "CPT" means that edition of the Current Procedure Terminology most current at the time of reference, as published annually by the American M…

(a) To be approved as a Medicaid/NJ FamilyCare provider by the New Jersey Medicaid/NJ FamilyCare program, the psychologist or psychologist specialist shall: 1. Complete and submit the Medicaid/NJ FamilyCare "Provider Application" (FD-20) and the "Medicaid/NJ FamilyCare Provider A…

(a) Psychologists shall keep such individual records as may be necessary to disclose fully the kind and extent of services provided and shall make such information available when requested by the New Jersey Medicaid/NJ FamilyCare program or its agents. The recordkeeping shall doc…

(a) Psychological services shall be reimbursed at the lesser of the psychologist's charges or the amount in the Maximum Fee Allowance Schedule for psychological services. (See N.J.A.C. 10:67-3.2 for the Maximum Fee Allowance Schedule.) (b) The Maximum Fee Allowance Schedule is ba…

(a) General policies regarding the collection of personal contribution to care for NJ FamilyCare Children's Program-Plan C and copayments for NJ FamilyCare-Plan D fee-for-service are set forth at N.J.A.C. 10:49-9. (b) Personal contribution to care for NJ FamilyCare-Plan C service…

(a) Psychological services reimbursed directly to the psychologist may be provided in settings such as an office, home, general hospital (inpatient), residential health care facility, nursing facility, or residential treatment center that is not enrolled as an approved Medicaid/N…

(a) Psychological services rendered to a Medicaid/NJ FamilyCare patient by an approved community mental health agency or by an approved independent clinic, or under the auspices of such agency or facility, or by a hospital outpatient department shall be billed directly by the age…

Notes N.J. Admin. Code § 10:67-2.3 Amended by R.1998 d.89, effective 2/17/1998. See: 29 N.J.R. 4615(a), 30 N.J.R. 734(a). In (d)2, updated the address. Amended by R.2003 d.182, effective 5/5/2003. See: 34 N.J.R. 4303(a), 35 N.J.R. 1901(a). Rewrote the section. Amended by R.2006 d…

(a) The New Jersey Medicaid and NJ FamilyCare programs adopted the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountabi…

Maximum Fee HCPCS Allowance MOD IND Code S $ NS N 90791 $167.21 $142.13 N 90832 $68.21 $28.83 N 90833 $70.33 $29.69 N 90834 $90.26 $37.83 N 90836 $88.79 $37.12 N 90837 $90.26 $36.73 N 90838 $89.04 $36.73 N 90839 $92.82 N 90846 HA 22 $24.50 N 90847 $113.94 $26.00 N 90847-22 $ 46.0…

Code Narrative 90791 Initial Comprehensive Psychiatric Evaluation QUALIFIER: A Medicaid/NJ FamilyCare provider who is a psychologist may bill this physician procedure code for parallel psychological services. This code requires, for reimbursement purposes, a minimum of 50 minutes…

The purpose of this chapter is to provide rules governing the provision of chiropractic services to Medicaid/NJ FamilyCare beneficiaries. Notes N.J. Admin. Code § 10:68-1.1 Amended by R.2000 d.451, effective 11/6/2000. See: 32 N.J.R. 2691(a), 32 N.J.R. 3992(b). Added "and NJ KidC…

(a) Coverage of a chiropractor's services shall be limited to treatment by means of manipulation of the spine, which the chiropractor is legally authorized by the State to personally perform (see 42 CFR 440.60). The chiropractor may prescribe certain services as outlined at N.J.A…

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise. "Chiropractor" means a doctor of chiropractic licensed to practice within the scope of that license issued by the New Jersey State Board of …

(a) Any chiropractor may apply to the New Jersey Medicaid/NJ FamilyCare program for approval as a provider, if he or she is a chiropractor licensed by the State Board of Chiropractic Examiners in accordance with N.J.A.C. 13:44E, or licensed by a comparable state agency in the sta…

(a) Reimbursement for covered chiropractic services provided to a Medicaid/NJ FamilyCare beneficiary is provided on the basis of the customary charge (fee-for-service) not to exceed an allowance determined reasonable by the Commissioner of the New Jersey State Department of Human…

(a) General policies regarding the collection of personal contribution to care for NJ FamilyCare-Plan C fee-for-service are set forth at N.J.A.C. 10:49-9. (b) Personal contribution to care for NJ FamilyCare-Plan C services is $ 5.00 for all procedure codes for manipulation of the…

(a) All chiropractors shall keep such individual records as are necessary to fully disclose the kind and extent of services provided in accordance with the rules of the Board of Chiropractic Examiners at N.J.A.C. 13:44E-2.2 and the Division, at N.J.A.C. 10:49-9.7 and 9.8. 1. This…

(a) Chiropractors may prescribe services within the scope of their license to practice and within the limitations of the New Jersey Medicaid/NJ FamilyCare programs. The prescriber shall ensure the patient's free choice of provider when ordering and/or prescribing services, such a…

(a) When chiropractic services are provided to a Medicaid/NJ FamilyCare beneficiary in a nursing facility, payment is not made for those services if provided by an owner, administrator, stockholder of the company, or corporation, or by anyone who otherwise has a direct financial …

Consultation between chiropractors shall not be reimbursed by the New Jersey Medicaid/NJ FamilyCare program, since there are no chiropractic specialists within the chiropractic discipline (see N.J.A.C. 10:68-1.3 for definition of consultation). Notes N.J. Admin. Code § 10:68-2.3 …

(a) A chiropractor shall not include any charges for laboratory services in a claim for reimbursement; however, he or she may order those professional and technical laboratory services for Medicaid/NJ FamilyCare beneficiaries that are consistent with chiropractic practice. The Ne…

(a) Medical supplies and durable medical equipment that are essential for the beneficiary's condition are reimbursable to an approved durable medical equipment or medical supplies provider under the following conditions: 1. The medical supplies and durable medical equipment shall…

(a) Physical therapy services, when prescribed by a chiropractor under his or her scope of practice (see N.J.A.C. 13:44E-2.12) shall be reimbursed to an approved provider, in accordance with this section. Providers shall secure prior authorization from the Division or its authori…

The New Jersey Medicaid/NJ FamilyCare program shall reimburse for diagnostic radiological services prescribed by a chiropractor within their scope of practice as determined by the New Jersey State Board of Chiropractic Examiners, or the applicable agency in the state in which the…

The New Jersey Medicaid/NJ FamilyCare programs adopted the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) codes for 2006, established and maintained by CMS in accordance with the Health Insurance Portability and Accountability Act…

HCPCS Maximum Code Description Fee Allowance 98940 Chiropractic Manipulative Treatment $ 6.00 Spinal, one or two regions 98941 Chiropractic Manipulative Treatment $ 6.00 Spinal, three or four regions 98942 Chiropractic Manipulative Treatment $ 6.00 Spinal, Five regions Y3433 Init…

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public Law 104-193, enacted August 22, 1996, implemented Federal welfare reform. The new Federal law eliminated the Aid to Families with Dependent Children (AFDC) program and created a Temporary Assistan…

The purpose of this chapter is to set forth the policies and procedures necessary for the orderly and equitable provision of AFDC-related Medicaid on a Statewide basis. It is binding on the county welfare agencies (CWAs) and enforceable by the Division of Medical Assistance and H…

(a) The Department of Human Services (Department) is the administrative unit of State government, which has the responsibility for the Medicaid program and is designated under Federal law as the "single State agency." (b) The Division of Medical Assistance and Health Services (DM…

(a) The AFDC-related Medicaid program is a State program with Federal participation. It is designed to make payments to providers for medical care and services on behalf of certain individuals whose income is determined to be inadequate to enable them to secure quality medical ca…

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise. "Adequate notice" means notice to a client of the county welfare agency (CWA) decision or action, which must state the nature, effective dat…

(a) As a condition of eligibility for the AFDC-related Medicaid program, applicants must comply with the income standards set forth in this subchapter. (b) It is the purpose of this subchapter to establish methods for evaluating income eligibility for families and children. Notes…

(a) Income may be earned, unearned or in the form of contributions. (b) Earned income shall not include the amount of Earned Income Credit payment that an individual receives. Notes N.J. Admin. Code § 10:69-10.10

(a) Earned income refers to gross income earned by an individual through the receipt of wages, tips, salaries or commissions from activities in which he or she is engaged as an employee or from his or her self-employment. It includes earnings over a period of time for which settl…

(a) With respect to self-employment, the term "earned income" means the total profit from a business enterprise (such as farming) resulting from a comparison of the gross receipts with the business expenses. Business expenses are those costs directly related to producing the good…

(a) The CWA shall disregard from the earned income of each employed individual in the eligible family, the first $ 90.00 of such earnings to cover work-related expenses including, but not limited to, transportation and mandatory payroll deductions. (b) The CWA shall disregard fro…

(a) Unearned income (including moneys to offset training expenses) received by an AFDC dependent child through the Job Training Partnership Act (JTPA) is exempt in the determination of initial eligibility, maximum income eligibility, and prospective needs test. (b) Earned income …

(a) The earned income of any child in the eligible unit who is a full-time student, or is a part-time student who is not a full-time employee, shall be exempt in determining need of the eligible unit and in evaluating his or her capacity as a legally responsible relative. (See N.…

(a) Payments by individuals or agencies for children placed in an eligible family's home for family day care shall be considered as gross earned income from self-employment. Earned income procedures for self-employment are discussed at N.J.A.C. 10:69-10.12. 1. The net income (adj…

(a) Division of Child Protection and Permanency's basic monthly payments for the placement of children in foster care and the clothing allowance shall be considered as equal to the cost of providing such care and maintenance. However, when extra payment is received for special se…

Net income from noneligible household members (except as stated in N.J.A.C. 10:69-10.12(c) ), returns from capital investment such as dividends and interest, benefits and pensions, annuities, contributions from relatives, compensation payments, and any other payments not consider…

Roomer-boarders or table boarders are noneligible household members. Notes N.J. Admin. Code § 10:69-10.19

(a) New Jersey has established the following monthly Standard of Need: Standard of Need Number in Monthly Family Standard 1 $ 410 2 $ 819 3 $ 985 4 $ 1,127 5 $ 1,260 6 $ 1,386 7 $ 1,505 8 $ 1,617 more than 8 add $ 112 each person Notes N.J. Admin. Code § 10:69-10.2

(a) When the eligible unit is receiving payment from rental of apartments, rooms or housekeeping units, the net income shall be determined by deducting the costs of operation and maintenance from the gross rental income received. 1. The costs of operation and maintenance are the …