New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 58 - NURSE MIDWIFERY SERVICES › Subchapter 3 - CENTERS FOR MEDICARE & MEDICAID SERVICES CMS HEALTHCARE COMMON PROCEDURE CODING SYSTEM HCPCS › Section 10:58-3.6 - HCPCS codes qualifiers for certified nurse midwifery services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Surgical services: Norplant System (NPS)
11975 WM
QUALIFIER: Reimbursed for the insertion and reinsertion of the
Norplant System (six Levonorgestrel Implants) and the
post-insertion visit when provided in a hospital setting, when
the CNM bills for the service. When using this procedure code,
the CNM will not be reimbursed for the cost of the kit. The
supplier of the kit to the CNM will be either reimbursed by
the hospital or be reimbursed directly for the cost of the
kit.
11975 WM 22
QUALIFIER: The maximum fee allowance includes the cost of the
kit supplied to the CNM, the insertion of the Norplant System
(six Levonorgestrel Implants), and the post-insertion visit.
NOTE: The "22" modifier indicates the inclusion of the cost of
the kit.
11976 WM
QUALIFIER: The maximum fee allowance is reimbursed for the
removal of the Norplant System (six Levonorgestrel Implants)
and the post-removal visit.
11977 WM
QUALIFIER: The maximum fee allowance is reimbursed for the
removal and reinsertion of the Norplant System (six
Levonorgestrel Implants) and the post-removal/reinsertion
visit.
11977 WM 22
QUALIFIER: The maximum fee allowance is reimbursed for the
removal and reinsertion of the "Norplant System" (six
Levonorgestrel Implants) and for the post-removal/reinsertion
visit. NOTE: Modifier "22" indicates that the billing includes
the cost of the NPS kit.
(b) Laboratory services:
36415
QUALIFIER: Once per visit, per patient. Not applicable if
laboratory study, in any part, is performed by the office
staff of the CNM or by CNM herself. When the clinical
laboratory test is performed on site, the venipuncture is not
reimbursable as a separate procedure; its cost is included
within the reimbursement for the laboratory procedure.
(c) Immunization:
W9098
QUALIFIER: This code applies only to high risk beneficiaries
who are 19 years of age.
W9335
QUALIFIER: This code applies only to high risk beneficiaries
who are over 18 years of age.
90741
QUALIFIER: Prior authorization form the Medical Consultant at
the Medicaid District Office is required.
90742
QUALIFIER: Prior authorization from the Medical Consultant at
the Medicaid District Office is required.
(d) Infusion therapy (excluding allergy, immunization and chemotherapy):
90772 SB
QUALIFIER: Reimbursement is contingent upon the required
medical necessity, and written chart documentation, including
time and the indication of the CNM's presence with the patient
to the exclusion of her other duties.
90774 SB
QUALIFIER: Reimbursement is contingent upon the required
medical necessity, and written chart documentation, including
time and the indication of the CNM's presence with the patient
to the exclusion of her other duties.
90775 SB
QUALIFIER: Reimbursement is contingent upon the required
medical necessity, and written chart documentation, including
time and the indication of the CNM's presence with the patient
to the exclusion of her other duties.
90779 SB
QUALIFIER: Reimbursement is contingent upon the required
medical necessity, and written chart documentation, including
time and the indication of the CNM's presence with the patient
to the exclusion of her other duties.
(e) Evaluation and management services:
For policy related to qualifiers for the following codes, see 10:58-2.3. (99201WM, 99202WM, 99203WM, 99204WM, 99211WM, 99212WM. 99213WM, 99214WM, 99215WM, 99221WM, 99231WM, 99232WM, 99351WM, 99352WM, 99384WM, 99385WM, 99386WM, 99387WM, 99394WM, 99395WM, 99396WM, 99397WM.)
1. Initial visit codes are as follows:
i. 99201WM, 99202WM
QUALIFIER: An Initial Office Visit is limited to a single visit. Future use of this category of codes will be denied when the beneficiary is seen by the same practitioner, group of practitioners, or member of the same shared health care facility.
ii. QUALIFIER: HCPCS procedure codes 99201WM and 99202WM are exceptions to the requirements outlined in the qualifier for the initial visit. For codes 99201WM and 99202WM, the provider is expected to follow the qualifier applied to routine visit or follow-up care visit for reimbursement purposes.
iii. QUALIFIER: Evaluation and Management services pertain to patients presenting with symptoms, and as such, exclude Preventive Health Care. Preventive services for patients through 20 years of age are billed under EPSDT, when the procedure requirements are met, as described at 10:58-2.3.