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 10:57-3.2 - HCPCS procedure codes and maximum fee allowance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) MEDICINE
IND
HCPCS Code
Mod
Maximum Fee Allowance S
$
NS
Anes Basic Units
90703
17.72
3.40
93922
22.00
21.00
93922
26
9.00
8.00
93922
TC
13.00
13.00
93923
45.00
42.00
93923
26
18.10
15.10
93923
TC
26.90
22.00
93965
30.00
28.00
93965
26
12.00
10.00
93965
TC
18.00
18.00
93970
62.00
58.00
93970
26
24.00
20.00
93970
TC
38.00
38.00
93971
30.00
28.00
93971
26
12.00
10.00
93971
TC
NA
18.00
96360
20.22
17.19
96361
7.12
6.05
96365
38.35
32.60
96366
11.39
9.68
96367
16.53
14.05
96368
11.03
9.37
96369
89.74
76.28
96370
8.13
6.91
96371
35.38
30.97
96372
8.72
7.41
96373
9.87
8.39
96374
20.78
17.66
96375
8.84
7.51
96376
14.14
12.01
96379
2.50
2.50
99025
22.00
17.00
99199
B.R.
B.R.
N
99201
24.78
21.06
N
99202
41.08
34.92
N
99203
58.02
49.31
N
99204
87.59
74.45
N
99205
109.89
93.40
N
99211
16.00
14.00
N
99212
24.41
20.22
N
99213
39.85
33.87
N
99214
58.21
49.48
N
99215
77.76
66.10
N
99217
38.64
32.84
N
99221
53.17
45.19
N
99222
71.88
61.10
N
99223
106.24
90.30
N
99231
23.50
20.60
N
99232
38.20
32.47
N
99233
54.59
46.40
N
99234
69.80
59.33
N
99235
88.90
75.56
N
99236
114.23
97.10
99238
38.64
32.84
N
99239
56.64
48.14
N
99241
44.00
37.00
N
99242
64.70
54.40
N
99243
64.70
54.40
N
99244
91.10
77.90
N
99245
91.10
77.90
N
99251
34.50
29.30
N
99252
64.70
54.40
N
99253
64.70
54.40
N
99254
91.10
77.90
N
99255
91.10
77.90
N
99261
16.00
14.00
99262
23.50
20.60
99263
23.50
20.60
99281
16.00
14.00
99282
23.50
20.60
99283
32.23
27.40
99284
61.11
51.94
99285
89.92
76.43
N
99304
45.67
38.82
N
99305
66.07
56.16
N
99306
84.57
71.88
N
99307
22.39
19.03
N
99308
35.08
29.81
N
99309
46.62
39.63
N
99310
68.95
58.60
N
99315
38.83
33.01
N
99316
55.80
47.43
N
99318
48.66
41.36
N
99324
28.06
23.85
N
99325
40.56
34.47
N
99326
70.36
59.81
N
99334
30.65
26.05
N
99335
48.26
41.02
N
99336
68.73
58.42
N
99341
29.18
24.81
N
99342
41.94
35.65
N
99343
63.82
58.07
99344
96.05
81.64
99345
116.83
99.30
N
99347
35.00
35.00
99348
51.50
51.50
99349
68.14
57.92
99350
94.43
80.26
N
99499
B.R.
B.R.
N
99600
B.R.
B.R.
(b) SURGERY
IND
HCPCS Code
Mod
Follow Up Days
Maximum Fee Allowance S
$
NS
Anes Basic Units
10021
0
49.00
45.00
3
10021
TC
0
19.00
19.00
0
10021
26
0
30.00
26.00
0
10022
0
87.00
78.00
3
10022
TC
0
26.00
26.00
0
10022
26
0
61.00
52.00
0
10060
0
13.00
11.00
3
10061
10
48.00
42.00
3
10120
0
18.00
16.00
3
10121
30
34.00
29.00
3
10140
0
18.00
16.00
3
10160
0
13.00
11.00
3
10180
14
100.00
85.00
3
11000
0
13.00
11.00
3
11001
0
6.00
5.00
3
11040
0
13.00
11.00
3
11041
0
13.00
11.00
3
11042
0
16.00
14.00
3
11043
0
23.93
20.34
3
11044
0
48.00
42.00
3
11055
0
13.00
11.00
3
11056
0
18.00
15.00
3
11057
0
23.00
20.00
3
11100
7
13.00
11.00
3
11101
0
5.00
4.00
3
11300
0
18.00
16.00
3
11301
0
22.00
20.00
3
11302
0
27.00
24.00
3
11303
0
32.00
27.00
3
11305
0
18.00
16.00
3
11306
0
22.00
20.00
3
11307
0
27.00
24.00
3
11308
0
32.00
27.00
3
11400
15
18.00
16.00
3
11401
15
22.00
20.00
3
11402
15
27.00
24.00
3
11403
15
32.00
27.00
3
11404
15
32.00
27.00
3
11406
15
32.00
27.00
3
11420
15
18.00
16.00
3
11421
15
22.00
20.00
3
11422
15
27.00
24.00
3
11423
15
32.00
27.00
3
11424
15
32.00
27.00
3
11426
15
32.00
27.00
3
11470
15
91.00
78.00
5
11600
90
37.00
32.00
3
11601
90
47.00
42.00
3
11602
90
61.00
53.00
3
11604
90
80.00
70.00
3
11606
90
92.00
80.00
3
11620
90
61.00
53.00
3
11621
90
90.00
79.00
3
11622
90
121.00
105.00
3
11623
90
140.00
121.00
3
11624
90
162.00
139.00
3
11626
90
186.00
160.00
3
11719
0
5.00
5.00
3
11720
0
13.00
11.00
3
E
11721
0
21.00
18.00
3
11730
0
11.58
9.84
3
11732
0
3.91
3.32
3
11740
0
16.00
14.00
3
11750
30
42.00
37.00
3
11752
30
59.00
50.00
3
11755
0
25.00
20.00
3
11760
60
42.00
37.00
3
11762
90
69.00
59.00
3
11765
60
21.00
18.00
3
11900
0
16.00
14.00
3
11901
0
16.00
14.00
3
11981
0
100.00
85.00
3
11982
0
100.00
85.00
3
11983
0
180.00
153.00
3
12001
0
18.00
16.00
3
12002
0
24.00
21.00
3
12004
0
30.00
26.00
3
12005
7
46.00
39.00
3
12006
7
57.00
48.00
3
12007
7
82.50
70.00
3
12020
7
57.00
48.00
5
12021
7
57.00
48.00
5
12041
30
30.00
26.00
3
12042
30
67.00
59.00
4
12044
30
82.50
70.00
4
12045
30
99.00
84.00
4
12046
30
110.00
94.00
4
12047
30
143.00
120.00
4
13131
30
67.00
59.00
4
13132
30
145.00
126.00
4
13160
30
121.00
103.00
3
13300
30
242.00
210.00
4
14040
60
193.00
168.00
4
14041
60
242.00
210.00
4
14300
60
242.00
210.00
4
14350
60
193.00
168.00
3
15000
10
70.50
60.00
3
15001
0
40.00
34.00
0
15050
30
62.87
53.44
4
15100
45
121.00
105.00
3
15101
45
61.00
53.00
4
15120
45
182.00
158.00
4
15121
45
61.00
53.00
4
15220
45
151.00
131.00
4
15221
30
76.00
65.00
3
15240
45
151.00
131.00
4
15241
30
76.00
65.00
3
15342
0
36.00
31.00
0
+
15343
0
12.00
10.00
0
15350
45
68.00
54.00
3
15351
0
54.00
46.00
0
15400
45
68.00
54.00
3
15401
0
50.00
43.00
0
15572
45
217.00
185.00
3
15574
45
217.00
185.00
5
15610
45
89.00
77.00
4
15620
45
121.00
105.00
4
15850
0
35.00
35.00
3
15851
0
35.00
35.00
3
15852
0
35.00
35.00
3
16000
0
16.00
14.00
5
16010
0
35.00
35.00
3
16015
0
100.00
85.00
3
16020
0
16.00
14.00
0
16025
0
24.00
20.00
0
16030
0
32.00
27.00
0
16035
0
21.07
17.91
3
+
16036
0
40.00
34.00
0
17000
0
16.00
14.00
3
17003
0
5.00
4.00
3
17004
0
52.00
46.00
3
17106
0
111.75
95.00
3
17107
0
212.80
180.90
3
17108
0
322.85
274.40
3
17110
0
16.00
14.00
3
17111
0
23.00
20.00
3
17250
0
16.00
14.00
3
17270
15
29.20
24.81
3
17271
15
43.74
37.20
3
17272
15
52.20
44.36
3
17273
15
61.48
52.26
3
17274
15
76.81
65.30
3
17276
15
94.27
80.15
3
17304
0
100.00
85.00
3
17305
0
25.00
21.00
3
17306
0
25.00
21.00
3
17307
0
25.00
21.00
3
17310
0
15.00
13.00
3
17340
0
18.00
15.00
3
20000
0
18.00
16.00
3
20005
0
45.00
40.00
4
20206
0
29.00
25.00
3
20520
7
51.00
45.00
3
20525
7
102.00
90.00
4
D
20550
0
13.00
11.00
5
E
20551
0
13.00
11.00
3
E
20552
0
13.00
11.00
3
E
20553
0
13.00
11.00
3
D
20600
0
13.00
11.00
3
D
20605
0
13.00
11.00
3
20615
0
80.00
68.00
3
20650
0
55.00
47.00
4
20670
0
42.82
36.40
3
20680
21
121.00
105.00
4
20690
0
65.48
55.66
5
20692
21
211.75
180.00
3
20693
21
136.15
115.00
3
20694
21
60.50
51.00
3
20838
90
400.00
340.00
4
20900
30
113.00
96.00
3
20957
60
616.00
524.00
6
27530
30
74.00
65.00
3
27532
90
121.00
105.00
3
27535
90
242.00
210.00
3
27536
90
242.00
210.00
3
27603
30
114.00
97.00
3
27604
0
54.65
46.45
3
27605
15
38.34
32.59
27606
30
63.00
54.00
3
27607
30
228.00
194.00
3
27610
60
182.00
158.00
3
27612
30
182.00
158.00
3
27613
0
28.18
23.95
3
27614
0
64.45
54.78
3
27615
60
228.00
194.00
3
27618
0
50.28
42.74
3
27619
30
57.00
49.00
3
27620
60
182.00
158.00
3
27625
90
211.00
184.00
3
27626
60
228.00
194.00
3
27630
30
90.00
79.00
3
27635
60
228.00
194.00
4
27637
60
285.00
243.00
4
27638
60
285.00
243.00
4
27640
60
211.00
184.00
4
27641
60
211.00
184.00
4
27645
90
342.00
291.00
4
27646
90
342.00
291.00
4
27647
90
371.00
316.00
4
27648
0
18.00
16.00
3
27650
90
227.00
197.00
4
27652
90
314.00
267.00
4
27654
90
314.00
267.00
4
27656
90
911.18
774.50
3
27658
90
121.00
105.00
3
27659
90
121.00
105.00
3
27664
90
90.00
79.00
3
27665
90
90.00
79.00
3
27675
30
171.00
146.00
3
27676
30
200.00
170.00
3
27680
30
143.00
122.00
3
27681
30
171.00
146.00
3
27685
90
151.00
131.00
4
27686
90
202.00
175.00
3
27687
30
171.00
146.00
3
27690
90
182.00
158.00
3
27691
90
342.00
291.00
3
E
27692
30
29.00
25.00
3
27695
90
302.00
263.00
3
27696
90
342.00
291.00
3
27698
90
227.00
197.00
3
27700
90
249.00
216.00
3
27705
90
272.00
236.00
3
27707
90
113.00
100.00
3
27709
90
350.00
298.00
3
27712
90
288.00
251.00
3
27715
90
570.00
485.00
4
27720
90
399.00
340.00
3
27722
90
428.00
364.00
3
27725
90
570.00
485.00
4
27727
90
570.00
485.00
4
27730
90
257.00
219.00
3
27732
30
143.00
122.00
3
27734
90
314.00
267.00
3
27740
90
302.00
263.00
3
27742
90
439.00
382.00
3
27745
60
200.00
170.00
3
27750
30
114.00
97.00
3
27752
90
121.00
105.00
3
27756
90
211.00
184.00
3
27758
90
314.00
267.00
3
27760
90
79.00
68.00
3
27762
90
79.00
68.00
3
27766
90
151.00
131.00
3
27780
7
45.00
39.00
3
27781
30
45.00
39.00
3
27784
90
121.00
105.00
3
27786
90
72.00
63.00
3
27788
90
79.00
68.00
3
27792
90
151.00
131.00
3
27808
30
100.00
85.00
3
27810
90
121.00
105.00
3
27814
90
211.00
184.00
3
27816
30
100.00
85.00
3
27818
90
121.00
105.00
3
27822
90
242.00
210.00
3
27823
90
242.00
210.00
3
27824
30
100.00
85.00
3
27825
90
121.00
105.00
3
27826
90
242.00
210.00
3
27827
90
242.00
210.00
3
27828
90
242.00
210.00
3
27829
90
305.00
263.00
3
27830
30
60.00
51.00
3
27831
30
80.00
68.00
3
27832
90
164.00
142.00
3
27840
45
61.00
53.00
0
27842
45
61.00
53.00
3
27846
90
305.00
263.00
3
27848
60
275.00
233.00
3
27860
0
61.00
53.00
3
27870
90
302.00
263.00
3
27871
90
302.00
263.00
3
27880
90
242.00
210.00
3
27881
60
266.00
226.00
3
27882
90
155.00
137.00
4
27884
0
63.93
54.34
4
27886
90
242.00
210.00
3
27888
90
242.00
210.00
3
27889
60
242.00
210.00
3
27892
90
127.00
108.00
3
27893
90
127.00
108.00
3
27894
90
147.00
125.00
3
28001
0
31.48
26.76
3
28002
0
49.26
41.87
3
28003
30
100.00
85.00
3
28005
30
150.00
128.00
3
28008
60
61.00
53.00
3
28010
0
25.77
21.90
3
28011
0
37.00
32.00
3
28020
60
109.00
95.00
3
28022
60
109.00
95.00
3
28024
60
52.18
44.35
3
28030
30
143.00
122.00
3
28035
30
171.00
146.00
3
28043
0
45.16
38.39
3
28045
0
57.00
49.00
3
28046
60
228.00
194.00
3
28050
30
171.00
146.00
3
28052
30
103.00
88.00
3
28054
30
86.00
74.00
3
28060
30
143.00
122.00
3
28062
60
228.00
194.00
3
28070
30
171.00
146.00
3
28072
30
103.00
88.00
3
28080
30
121.00
105.00
3
28086
30
160.00
136.00
3
28088
30
114.00
97.00
3
28090
30
90.00
79.00
3
28092
30
61.00
53.00
3
28100
60
121.00
105.00
4
28102
60
200.00
170.00
3
28103
60
200.00
170.00
3
28104
30
143.00
122.00
4
28106
60
200.00
170.00
3
28107
60
200.00
170.00
3
28108
60
121.00
105.00
4
28110
30
69.00
59.00
3
28111
30
171.00
146.00
3
28112
30
103.00
88.00
3
28113
30
103.00
88.00
3
28114
90
242.00
210.00
3
28116
30
171.00
146.00
3
28118
30
143.00
122.00
3
28119
30
143.00
122.00
3
28120
60
90.00
79.00
4
28122
60
90.00
79.00
4
28124
60
90.00
79.00
4
28126
30
143.00
122.00
3
28130
90
211.00
184.00
3
28140
60
121.00
105.00
3
28150
90
90.00
79.00
3
28153
30
69.00
59.00
3
28160
90
90.00
79.00
3
28171
90
371.00
316.00
3
28173
90
371.00
316.00
3
28175
90
371.00
316.00
3
28190
0
29.14
24.77
3
28192
30
52.85
44.92
4
28193
30
59.81
50.84
4
28200
90
121.00
105.00
3
28202
30
161.00
137.00
3
28208
90
61.00
53.00
3
28210
30
103.00
88.00
3
28220
60
113.00
99.00
3
28222
60
139.00
119.00
3
28225
60
113.00
99.00
3
28226
60
139.00
119.00
3
28230
30
49.26
41.87
3
28232
60
139.00
119.00
3
28234
60
139.00
119.00
3
28238
30
171.00
146.00
3
28240
30
61.00
53.00
3
28250
30
143.00
122.00
3
28260
30
171.00
146.00
3
28261
60
200.00
170.00
3
28262
60
212.00
184.00
3
28264
60
285.00
243.00
3
28270
30
69.00
59.00
3
28272
30
44.48
37.80
3
28280
45
61.00
53.00
3
28285
90
90.00
79.00
3
28286
30
68.00
57.00
3
28288
21
72.00
63.00
3
28289
90
228.00
194.00
3
28290
60
90.00
79.00
3
28292
90
139.00
121.00
3
28293
90
242.00
210.00
3
28294
90
141.00
123.00
3
28296
60
200.00
170.00
3
28305
60
217.00
185.00
3
28306
90
113.00
100.00
3
28307
60
217.00
185.00
3
28308
90
113.00
100.00
3
28309
60
257.00
219.00
3
28310
30
69.00
59.00
3
28312
30
58.55
49.77
3
28313
90
90.00
79.00
3
28315
60
55.00
47.00
3
28320
60
200.00
170.00
3
28322
30
143.00
122.00
3
28340
90
90.00
79.00
3
28341
90
90.00
79.00
3
28344
45
63.12
53.65
3
28345
90
90.00
79.00
3
28400
30
68.00
59.00
3
28405
90
90.00
79.00
3
28406
60
228.00
194.00
3
28415
90
151.00
131.00
3
28420
90
300.00
255.00
3
28430
30
82.00
72.00
3
28435
90
90.00
79.00
3
28436
30
175.00
149.00
3
28445
60
275.00
234.00
3
28450
30
41.00
36.00
3
28455
90
61.00
53.00
3
28456
30
121.00
103.00
3
28465
90
121.00
105.00
3
28470
30
24.58
20.72
3
28475
90
42.00
37.00
3
28476
30
82.00
70.00
3
28485
90
90.00
79.00
3
28490
30
18.00
16.00
3
28495
30
30.00
26.00
3
28496
30
60.00
51.00
3
28505
30
120.00
102.00
3
28510
30
18.00
16.00
3
28515
30
30.00
26.00
3
28525
30
90.00
77.00
3
28530
30
18.00
16.00
3
28531
30
59.00
50.00
3
28540
45
61.00
53.00
0
28545
45
61.00
53.00
3
28546
30
69.00
59.00
3
28555
90
211.00
184.00
3
28570
45
61.00
53.00
0
28575
45
61.00
53.00
3
28576
45
118.00
100.00
3
28585
90
211.00
184.00
3
28600
45
61.00
53.00
0
28605
45
61.00
53.00
3
28606
30
69.00
59.00
3
28615
30
143.00
122.00
3
28630
45
61.00
53.00
0
28635
7
65.00
55.00
3
28636
7
85.00
72.00
3
28645
90
121.00
105.00
3
28660
0
16.00
14.00
0
28665
0
35.00
30.00
3
28666
45
80.00
68.00
3
28675
60
65.73
55.87
3
28705
90
361.00
307.00
3
28715
90
272.00
236.00
3
28725
90
182.00
158.00
3
28730
60
203.00
173.00
3
28735
60
226.00
192.00
3
28737
60
200.00
170.00
3
28740
90
166.00
126.00
3
28750
90
90.00
79.00
3
28755
90
90.00
79.00
3
28760
90
200.00
173.00
3
28800
90
211.00
184.00
3
28805
90
211.00
184.00
3
28810
90
121.00
105.00
3
28820
45
63.67
54.12
3
28820
50
45
94.96
80.71
3
28825
45
60.94
51.80
3
28825
50
45
90.89
77.25
3
28899
0
B.R.
B.R.
0
29345
0
53.00
42.00
3
29355
0
47.00
42.00
3
29358
2
41.00
34.85
3
29365
0
53.00
42.00
3
E D
29405
0
42.00
37.00
3
E D
29425
0
47.00
42.00
3
E D
29435
0
66.00
53.00
3
E D
29440
0
12.00
10.00
3
E D
29450
0
24.00
21.00
3
E D
29450
50
0
37.00
32.00
3
E D
29505
0
48.00
42.00
3
E D
29515
0
42.00
37.00
3
E D
29540
0
18.00
16.00
3
E D
29550
0
16.00
14.00
3
E D
29580
0
18.00
16.00
3
E D
29590
0
12.00
10.00
3
E D
29700
0
14.00
12.00
3
E D
29705
0
14.00
12.00
3
E D
29730
0
9.00
8.00
3
E D
29740
0
11.05
9.39
3
E D
29750
0
11.32
9.62
3
E D
29750
50
0
15.00
13.00
3
E D
29799
0
B.R.
B.R.
0
29891
90
236.00
201.00
3
29892
90
243.00
206.00
3
29893
90
137.00
116.00
3
29894
30
100.00
85.00
3
29895
90
200.00
170.00
4
29897
60
100.00
85.00
3
29898
60
150.00
128.00
3
29899
90
225.00
191.00
3
29909
0
BR
BR
0
29999
90
BR
BR
3
E D
36410
0
18.00
16.00
0
E N D
36415
0
1.80
1.80
0
36470
0
16.70
14.19
36471
0
20.03
17.02
E
64450
0
18.00
16.00
0
64614
10
77.00
65.00
0
64702
90
79.00
68.00
3
64704
90
105.00
91.00
3
64708
90
242.00
210.00
3
64726
90
90.00
77.00
3
64774
30
45.96
39.06
3
64776
30
53.00
45.00
3
64778
30
30.00
26.00
3
64782
30
79.00
68.00
3
64783
30
70.00
60.00
3
64784
30
131.00
114.00
4
64831
90
79.00
68.00
3
64832
30
43.00
37.00
3
64834
90
105.00
91.00
3
64856
90
210.00
183.00
3
64857
90
158.00
137.00
3
97601
0
35.00
30.00
0
NOTE: "+" means that these add-on codes are always performed in addition to the primary procedure only, by the same practitioner. These add-on codes are exempt from multiple surgical pricing methodologies.
(c) RADIOLOGY
IND
HCPCS Code
Mod
Maximum Fee Allowance S
$
NS
Annes Basic Units
73600
10.00
3
73600
26
3.60
73600
TC
6.40
73610
13.00
3
73610
26
5.40
73610
TC
7.60
73615
28.80
3
73615
26
10.80
73615
TC
18.00
73620
10.00
3
73620
26
3.60
73620
TC
6.40
73630
13.00
3
73630
26
5.40
73630
TC
7.60
73650
10.00
3
73650
26
3.60
73650
TC
6.40
73660
5.00
3
73660
26
3.60
73660
TC
1.40
(d) PATHOLOGY & LABORATORY SERVICES
IND
HCPCS Code
Mod
Maximum Fee Allowance
81000
1.20
82948
1.50
85002
1.20
85008
1.20
86671
15.00
87070
9.00
87076
6.00
87084
3.00
87101
8.00
87102
8.00
87103
8.00
87106
8.00
87210
2.40
87220
2.40