New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 77 - REHABILITATIVE SERVICES FOR CHILDREN › Subchapter 7 - CENTERS FOR MEDICARE & MEDICAID SERVICES' HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:77-7.2 - HCPCS procedure code numbers and maximum fee allowance schedule

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Environmental Lead Inspection Codes:
HCPCS Code
Description
Maximum Fee
						  Allowance
Y 9733
Initial Inspection for Lead
$
						  260.00
Y 9734
Reinspection for
						  Lead
100.00
Qualifier: Limit of two reinspections
						  per
primary residence per family
(b)
				Mental Health Rehabilitation Services provided in psychiatric community
				residences for youth, group homes, or residential childcare facilities:
IND
HCPCS Code
MOD
Procedure
						  Code Definition
Maximum Fee Allowance
P
H0018
TJ
Mobile Response-Crisis
						  Bed. For services rendered in psychiatric community residences for youth, group
						  homes or residential childcare facilities to a child, youth or young adult
						  receiving mobile response and stabilization management services (per diem, not
						  to exceed seven days)
$ 50.00 per diem
Y9933
Mental health rehabilitation services provided in
						  non-JCAHO accredited residential treatment centers licensed as community
						  psychiatric residences for youth licensed by the Division of Mental Health and
						  Addiction Services, under N.J.A.C. 10:128
Contract pricing
Y9934
Mental health rehabilitation services provided in
						  therapeutic foster care facilities, licensed by the Division of Child
						  Protection and Permanency, that contract with the Division of Mental Health and
						  Addiction Services under N.J.A.C. 10:128.
Contract pricing
Y9935
Mental health rehabilitation services provided in group
						  homes (serving six to 12 children) licensed by the Division of Child Protection
						  and Permanency, under N.J.A.C. 10:128.
Contract pricing
Y9936
Mental health rehabilitation services provided in
						  supervised transitional living homes licensed by the Division of Child
						  Protection and Permanency, under N.J.A.C. 10:128.
Contract pricing
Y9937
Mental health rehabilitation services provided in
						  teaching family homes licensed by the Division of Child Protection and
						  Permanency, under N.J.A.C. 10:128.
Contract pricing
Y9938
Mental health rehabilitation services provided in
						  treatment homes licensed by the Division of Child Protection and Permanency,
						  under N.J.A.C. 10:128.
Contract Pricing
Y9939
Mental health rehabilitation services provided in
						  alternative care homes licensed by the Division of Child Protection and
						  Permanency, under N.J.A.C. 10:128.
Contract pricing
Y9943
Mental health rehabilitation services provided in
						  non-JCAHO residential child care facilities licensed by the Division of Child
						  Protection and Permanency, under N.J.A.C. 10:127.
Contract pricing
Y9944
Room and board for mental health rehabilitation services
						  provided in facilities under contract with the Division of Child Protection and
						  Permanency, under N.J.A.C. 10:127 and 10:128.
Contract pricing
Y9945
Room and board for mental health rehabilitation services
						  provided in facilities under contract with the Division of Mental Health and
						  Addiction Services, under N.J.A.C. 10:128.
Contract pricing
Y9946
All other room and board for mental
						  health rehabilitation services.
Contract pricing
Y9947
Mental health rehabilitation services provided in JCAHO
						  accredited RTCs licensed by the Division of Mental Health and Addiction
						  Services (DMHAS), under N.J.A.C. 10:128.
Contract pricing
Y9948
Mental health rehabilitation services provided in JCAHO
						  accredited RTCs licensed by the Division of Child Protection and Permanency
						  (DCP&P), under N.J.A.C. 10:127.
Contract pricing
Y9992
Therapeutic Leave for Rehabilitation Services provided
						  in non-JCAHO accredited facilities under contract with DMHAS
Contract pricing
Y9993
Therapeutic Leave for Room and Board Board Services
						  provided in non-JCAHO accredited facilities under contract with DMHAS
Contract pricing
Y9994
Hospital Leave for Rehabilitation Services provided in
						  non-JCAHO accredited facilities under contract with DMHAS
Contract pricing
Y9995
Hospital Leave for Room and Board Services provided in
						  non-JCAHO accredited facilities under contract with DMHAS
Contract pricing
Y9996
Therapeutic Leave for Rehabilitation Services provided
						  in non-JCAHO accredited facilities under contract with DCP&P
Contract pricing
Y9997
Therapeutic Leave for Room and Board Board Services
						  provided in non-JCAHO accredited facilities under contract with DCP&P
Contract pricing
Y9998
Hospital Leave for Rehabilitation Services provided in
						  non-JCAHO accredited facilities under contract with DCP&P
Contract pricing
Y9999
Hospital Leave for Room and Board Services provided in
						  non-JCAHO accredited facilities under contract with DCP&P
Contract pricing
(c)
				Behavioral Assistance Services Codes:
IND
HCPCS Code
MOD
Procedure Code Definition
Maximum Fee Allowance
P
H2014
TJ
Individual
						  behavioral assistance services. (15-minute unit of service)
$18.19/unit
P
H2014
TJ UN
Group behavioral
						  assistance services. Services are limited to those provided directly to, or in
						  support of, two children/youth or young adults. (15-minute unit of
						  service)
$11.10/unit per child
P
H2014
TJ UP
Group
						  behavioral assistance services. Services are limited to those provided directly
						  to or in support of three children/youth or young adults. (15-minute unit of
						  service)
$30.83/unit per child
P
S5125
TJ
Individual
						  behavioral assistance services in non-Title XIX eligible locations. (15-minute
						  unit of service)
$ 9.75 ($ 39.00 per hour)
P
S5125
TJ UN
Small group
						  behavioral assistance services in non-Title XIX eligible locations. Services
						  are limited to those provided directly or in support of two children/youth or
						  young adults. (15-minute unit of service)
$ 5.62/unit per child
P
S5125
TJ UP
Small group
						  behavioral assistance services in non-Title XIX eligible locations. Services
						  are limited to those provided directly or in support of three children/youth or
						  young adults. (15-minute unit of service)
$ 4.25/unit per child
(d)
				Mobile response and stabilization management services codes:
IND
HCPCS Code
MOD
Procedure Code Definition
Maximum Fee Allowance
P
S9485
TJ
Mobile
						  Response-Initial (one unit of service per episode, not to exceed 72 hours,
						  spanning up to four days)
$1,320 per unit of service
P
H0032
TJ
Mobile
						  Response-Care Coordination and Stabilization Plan (15 minute units of service,
						  not to exceed a total of 64 units or 16 hours, up to eight weeks as authorized
						  weekly)
$8.40 per unit of service
(e)
				Intensive in-community mental health rehabilitation services:
IND
HCPCS Code
MOD 1&2
Procedure Code Definition
Maximum Fee Allowance
P
H0036
TJ U3
Supportive
						  service level (intensive in-community services delivered by, at a minimum, a
						  bachelor's level direct care provider) Individual, 15 minute units of
						  service
$ 18.25 per unit of service. ($ 73.00 per hour)
P
H0036
TJ U2
Professional
						  service level (intensive incommunity services delivered by, at a minimum, a
						  master's level direct care provider) Individual, 15-minute unit of
						  service
$28.74 per unit of service. ($114.96 per hour)
P
H0036
TJ HQ
Professional
						  service level (intensive in-community services delivered by, at a minimum, a
						  master's level direct care provider) Group, 15 minute units of
						  service
Contract Pricing
P
H0036
TJ U1
Clinical
						  level services(intensive in-community services delivered by a licensed
						  behavioral health care practitioner) Individual, 15-minute unit of
						  service
$30.83 per unit of service ($123.32 per hour)
P
H0036
U1 UN
Clinical
						  level services (intensive in-community services delivered by a licensed
						  behavioral healthcare practitioner) Group services provided directly to, or in
						  support of, two children, youth or young adults, 15-minute unit of
						  service.
$20.17/unit per child
P
H0036
U2 UN
Professional
						  service level (intensive incommunity services delivered by, at a minimum, a
						  master's level direct care provider) Group services provided directly to, or in
						  support of, two children, youth, or young adults, 15-minute unit of
						  service
$18.45/unit per child
P
H0036
U1 UP
Clinical
						  level services (intensive in-community services delivered by a licensed
						  behavioral healthcare practitioner) Group services provided directly to, or in
						  support of, three children, youth, or young adults, 15-minute unit of
						  service.
$17.45/unit per child
P
H0036
U2 UP
Professional
						  service level (intensive incommunity services delivered by, at a minimum, a
						  master's level direct care provider) Group services provided directly to, or in
						  support of, three children, youth, or young adults, 15-minute unit of
						  services
$15.02/unit per child