New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 52 - HOSPITAL SERVICES MANUAL › Subchapter 10 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) FOR HOSPITAL OUTPATIENT LABORATORY SERVICES › Section 10:52-10.3 - HCPCS Code Numbers, Procedure Description and Maximum Fee Schedule; Pathology/Laboratory (Codes and Narratives Not Found in CPT)

Current through Register Vol. 56, No. 14, July 15, 2024
PATHOLOGY/LABORATORY
HCPCS
Maximum Fee
IND
Code
MOD
Procedure Description
Allowance
G0027
Semen analysis; presence
2.40
and/or motility of sperm
excluding Huhner test
G0123
Screening cytopathology,
23.50
cervical or vaginal, thin
prep, auto
G0141
Screening cytopathology
10.00
smears, cervical or vaginal
performed by automated
system, with manual
rescreening requiring
interpretation by physician
G0306
Complete CBC, automated
5.00
(HGB, HCT, RBC, WBC, without
platelet count) and automated
WBC differential count
G0307
Complete CBC, automated
4.80
(HGB, HCT, RBC, WBC, without
platelet count)
G0328
Colorectal cancer
7.00
screening; fecal-occult blood
test, immunoassay, 1-3
simultaneous determinations
J0886
Injection, Epoetin Alpha,
13.31
1000 units (for ESRD patients
on dialysis)
P3000
Screening Papanicolaou
6.00
smear, cervical or vaginal,
up to three smears; by
technician under physician
supervision
P3001
Requiring interpretation
6.00
by physician
P9010
Blood transfusion, whole
S.C.C.
blood (per unit)
P9011
Blood transfusion, split
S.C.C.
unit, (specify amount)
P9012
Cryopreipitate, each unit
S.C.C.
P9016
Leukocyte poor blood, each
S.C.C.
unit
P9017
Fresh frozen plasma,
S.C.C.
single
P9019
Platelets, each unit
S.C.C.
P9020
Platelet rich plasma, each
S.C.C.
unit
P9021
Red blood cells, each unit
S.C.C.
P9022
Red blood cells, washed,
S.C.C.
each unit
P9023
Plasma, pooled multiple,
S.C.C.
donor solvent/detergent
treated, frozen, each unit
P9031
Platelets, leukocytes
S.C.C.
reduced, each unit
P9032
Platelets, irradiated,
S.C.C.
each unit
P9033
Platelets, leukocytes
S.C.C.
reduced, irradiated, each
unit
P9034
Platelets, pheresis, each
S.C.C.
unit
P9035
Platelets, pheresis,
S.C.C.
leukocytes reduced, each unit
P9036
Platelets, pheresis,
S.C.C.
irradiated, each unit
P9037
Platelets, pheresis,
S.C.C.
leukocytes reduced,
irradiated, each unit
P9038
Red blood cells,
S.C.C.
irradiated, each unit
P9039
Red blood cells,
S.C.C.
deglycerolized, each unit
P9040
Red blood cells,
S.C.C.
leukocytes reduced,
irradiated, each unit
P9041
Infusion, albumin (human),
S.C.C.
5%, 50ml
P9043
Infusion, plasma protein
S.C.C.
fraction (human), 5%, 50ml
P9044
Plasma, cryoprecipitate
S.C.C.
reduced, each unit
P9045
Infusion, albumin (human),
S.C.C.
5%, 250 ml
P9046
Infusion, albumin (human),
S.C.C.
25%, 20ml
P9047
Infusion, albumin (human)
S.C.C.
25%, 50ml
P9051
Whole blood or red blood
S.C.C.
cells, leukocytes reduced,
cmv-negative, each unit
P9052
Platelets, hla-matched
S.C.C.
leukocytes reduced,
apheresis/pheresis, each unit
P9053
Platelets, pheresis,
S.C.C.
leukocytes, reduced,
cmv-negative, irradiated each
unit
P9056
Whole blood, leukocytes
S.C.C.
reduced, irradiated, each
unit
P9058
Red blood cells,
S.C.C.
leukocytes reduced, each unit
P9060
Fresh frozen plasma, donor
S.C.C.
retested, each unit
P9604
Prorated trip charge
1.38
P9612
Catheterization for
1.80
collection of urine; all
places of service
P9615
Catheterization for
1.80
collection of (urine)
specimen(s), (multiple)
patients
QUALIFIER: This service is
reimbursable at a fixed rate
or at the amount of the
hospital charge (whichever is
less) per specimen type, per
patient encounter, regardless
of the number of patient
encounters per day.
Q0111
Wet mount, including
2.40
preparations of vaginal,
cervical or skin specimens
Q0112
All potassium hydroxide
2.40
(KOH) preparations
Q0113
Pinworm examination
5.10
Q0114
Fern test
9.60
Q0115
Post-coital direct,
12.33
qualitative examinations of
vaginal or cervical mucous
Q4081
Injection, epoetin alfa,
1.33
100 units (for ESRD on
dialysis)