New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 57 - PODIATRY SERVICES › Subchapter 3 - CENTERS FOR MEDICARE AND MEDICAID SERVICES CMS HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:57-3.4 - Qualifiers for podiatry services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following is a list of HCPCS codes with their associated qualifiers. Providers shall use the following procedure codes in billing each of the procedures.
1. HCPCS 36415--Maximum units per date of service is 10. Not applicable if the laboratory study, in any part, is performed by the office staff or by the provider.
2. HCPCS 87070, 87081--Culture codes. May only be billed when a pathogenic microorganism is reported. A culture that indicates no growth or normal flora must be billed as a presumptive culture, 87081.
3. HCPCS 96360--IV infusion therapy. Not to be used for routine IV drug injection or infusion. Reimbursement is contingent upon the required medical necessity, handwritten chart documentation, including time and indication of physician's presence with the patient to the exclusion of his other duties.
4. HCPCS 96361--IV infusion therapy. Not be used for routine IV drug injection or infusion. Reimbursement is contingent upon the required medical necessity, handwritten chart documentation, including time and indication of podiatrist's presence with the patient to the exclusion of his or her other duties.
5. HCPCS 99201, 99202, 99203, 99204, 99205, 99221, 99222, 99223, 99304, 99305, 99306, 99324, 99325, 99326--Office or other outpatient services--new patient; Hospital inpatient services--initial hospital care; Nursing facility services--comprehensive nursing facility assessments; and Domiciliary, Rest home, or Custodial care services--new patient.
i. Excludes Preventive Health Care for patients through 20 years of age.
6. HCPCS 99211, 99212, 99213, 99214, 99215, 99231, 99232, 99233, 99307, 99308, 99309, 99310, 99318, 99334, 99335, 99336--Office or other outpatient services--established patient; Hospital inpatient services--subsequent hospital care; Nursing facility services--subsequent nursing facility care; and Domiciliary, Rest home or Custodial care services--established patient.
i. Excludes Preventive Health Care for patients through 20 years of age.
7. HCPCS 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, and 99600 Home services and House calls.
i. Do not distinguish between specialist and nonspecialist.
ii. These codes do not apply to residential health care facility or nursing facility setting.
iii. HCPCS 99341, 99342, 99344, 99345, 99347, 99348, 99349 and 99350 apply when the provider visits the Medicaid or NJ FamilyCare fee-for-service beneficiary in their home setting and the visit does not meet the criteria specified under House Call listed above.
iv. The HCPCS codes 99244, 99245, 99254, and 99255 shall be utilized for Comprehensive consultation.
(1) HCPCS 99244, 99245, 99254, and 99255, require a comprehensive evaluation by history and physical examination within the scope of a podiatric specialist's practice. An alternative to that would be the utilization of one or more hours of the consulting podiatrist's personal time in the performance of the consultation.
(2) HCPCS 99244, 99245, 99254, and 99255, require the following applicable statements, or language essentially similar to those statements, to be inserted in the "remarks" section of the claim form. The form is to be signed by the podiatrist who performed the consultation.
Examples:
"I personally performed a comprehensive evaluation by history and physical examination within the scope of my podiatric practice as a specialist." or
"This consultation utilized 60 or more minutes of my personal time."
8. The HCPCS codes 99241, 99242, 99243, 99251, 99252, and 99253, shall be utilized for Limited consultation. The area being covered for reimbursement purposes is "limited" in the sense that it requires less than the requirements designated as comprehensive consultation as noted above.
9. For procedure codes L3000 through L3003; L3010, L3020, L3030, L3040, L3050, L3060, L3070, L3080 and L3090, up to four units of orthotics may be provided by the same provider to the same beneficiary during a 12-month period.
10. For procedure codes L3201 through L3207; L3215 through L3217; L3219, L3221 and L3222, up to two units may be provided by the same provider to the same beneficiary during a 12-month period.
11. HCPCS procedure codes L3001, L3002, L3003, L3010, L3020, L3030, L3040, L3050, L3060, L3070, L3080, L3090, L3215 through L3223, and L3201 through L3207 do not require prior authorization for the following diagnosis codes: 343.0 to 343.9, 707.0 to 707.9, 711.0 to 712.9, 715.0 to 722.9, 724.0 to 728.9, 730.0 to 737.9, 754.2 to 754.79, 755.0 to 755.39, 755.6 to 755.69, 756.1 to 756.19, 756.8 to 756.89, and 892.0 to 897.7.