New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 66 - INDEPENDENT CLINIC SERVICES › Subchapter 6 - CENTERS FOR MEDICARE & MEDICAID SERVICES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:66-6.2 - HCPCS procedure code numbers and maximum fee allowance schedule

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Evaluation and management and other procedures
* An asterisk preceding any procedure code may also be
				  performed in a substance use disorder treatment facility.
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
*N
36415
1.80
1.80
N
67221
90
283.00
241.00
N
67225
23.00
20.00
90746
65.25
65.25
93000
16.00
16.00
93005
11.00
11.00
93010
5.00
5.00
93012
11.00
9.00
93014
5.00
4.25
93015
80.00
68.00
93016
10.00
10.00
93017
35.00
35.00
93018
13.51
11.49
93268
32.00
27.00
93268
TC
19.00
19.00
93268
26
13.00
11.00
93270
17.00
14.00
93271
35.00
30.00
93272
20.00
17.00
96372
2.50
2.50
96373
9.47
8.05
96374
32.22
27.39
96401
36.09
30.68
96402
22.34
18.99
96405
16.00
14.00
96406
20.00
17.00
96409
66.57
56.58
96411
37.94
32.24
96413
90.24
76.70
96415
19.96
16.96
96416
98.05
83.34
96417
44.34
37.69
96420
16.00
14.00
96422
32.00
28.00
96423
16.00
14.00
96425
16.00
14.00
96440
38.00
32.00
96445
38.00
32.00
96450
61.00
52.00
96521
78.82
67.00
96522
62.77
53.35
96542
61.00
52.00
99173
5.00
5.00
N
99201
23.50
20.60
N
99201
SA
NA
19.60
N
99201
SB
NA
16.50
N
99202
23.50
20.60
N
99202
SA
NA
19.60
N
99202
SB
NA
16.50
N
99203
32.30
25.00
N
99203
SA
NA
23.80
N
99203
SB
NA
22.60
N
99203
UD
32.30
25.00
N
*99204
32.30
25.00
N
99204
SA
NA
23.80
N
99204
SB
NA
22.60
N
*99205
32.30
25.00
N
99211
16.00
14.00
N
99211
SA
NA
13.30
N
99211
SB
NA
11.20
N
99212
23.50
20.60
N
99212
SA
NA
19.60
N
99212
SB
NA
16.50
N
*99213
23.50
20.60
N
99213
SA
NA
19.60
N
99213
SB
NA
16.50
N
99213
UD
23.50
20.60
N
*99214
23.50
20.60
N
99214
SA
NA
19.60
N
99214
SB
NA
16.50
N
99215
23.50
20.60
99215
SA
NA
19.60
N
99215
SB
NA
16.50
99217
23.50
20.60
99221
32.30
25.00
99221
SA
NA
23.80
99221
SB
NA
22.60
99222
32.30
25.00
99223
32.30
25.00
99231
23.50
20.60
99231
SA
NA
19.60
99231
SB
NA
16.50
99232
23.50
20.60
99232
SA
NA
19.60
99232
SB
NA
16.50
99233
23.50
20.60
99234
55.90
47.00
99235
55.90
47.00
99236
55.90
47.00
99238
23.50
20.60
99239
23.50
20.60
N
99241
44.00
37.00
N
99242
64.70
54.40
N
99243
64.70
54.40
N
99244
91.10
77.90
99244
SM
73.50
62.50
99244
SN
73.50
62.50
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
99261
16.00
14.00
99262
23.50
20.60
99263
23.50
20.60
99281
16.00
14.00
99281
SA
NA
13.30
99282
23.50
20.60
99282
SA
NA
19.60
99283
23.50
20.60
99283
SA
NA
19.60
99284
32.30
25.00
99284
SA
NA
23.80
99285
32.30
25.00
N
99291
66.20
58.80
N
99292
33.10
29.40
N
99354
66.20
58.80
N
99354
SA
NA
55.90
N
99355
33.10
29.40
N
99355
SA
NA
27.90
99356
66.20
58.80
99357
33.10
29.40
99381
80.06
68.05
99381
22
80.06
68.05
99381
SA
NA
64.65
99381
EP SA
NA
64.65
99381
22 EP
80.06
68.05
99381
22 SA
NA
64.65
99382
86.53
73.55
99382
EP
86.53
73.55
99382
EP SA
NA
69.87
99382
22 EP
86.53
73.55
99382
SA
NA
69.87
99382
SA 52
NA
69.87
99382
22
86.53
73.55
99382
22 SA
NA
69.87
*99383
85.17
72.39
99383
EP
85.17
72.39
99383
SA
NA
68.77
99383
SA 52
NA
68.77
*99384
92.67
78.77
99384
EP
92.67
78.77
99384
SA
NA
74.83
99384
SA 52
NA
74.83
99384
SB
NA
64.87
*99385
32.30
25.00
99385
EP
92.67
78.77
99385
SA
NA
23.80
99385
SA 52
NA
23.80
99385
SB
NA
22.60
*99386
32.30
25.00
99386
SA
NA
23.80
99386
SB
NA
22.60
*99387
32.30
25.00
99387
SA
NA
23.80
99387
SB
NA
22.60
99391
64.05
54.44
99391
SA
NA
51.72
99391
EP
64.05
54.44
99391
22
64.05
54.44
99391
EP SA
NA
51.72
99391
22 EP
64.05
54.44
99392
71.54
60.81
99392
EP
71.54
60.81
99392
22
71.54
60.81
99392
SA
NA
51.72
99392
22 SA
NA
51.72
99392
EP SA
NA
51.72
99392
22 EP
71.54
60.81
99392
SA 52
NA
51.72
*99393
70.86
60.23
99393
SA
NA
57.22
99393
EP
70.86
60.23
99393
SA 52
NA
57.22
*99394
77.68
66.03
99394
EP
77.68
66.03
99394
SA
NA
62.73
99394
SA 52
NA
62.73
99394
SB
NA
54.38
*99395
32.30
25.00
99395
EP
78.36
66.61
99395
SA
NA
23.80
99395
SA 52
NA
23.80
99395
SB
NA
22.60
99396
32.30
25.00
99396
SA
NA
23.80
99396
SB
NA
22.60
*99397
32.30
25.00
99397
SA
NA
23.80
99397
SB
NA
22.60
99460
51.37
43.66
99460
SA
NA
41.48
99461
73.46
62.44
99463
69.22
58.83
99463
SA
NA
55.89
99464
65.14
55.37
99465
127.74
108.58
(b)
				Dental services (See N.J.A.C. 10:56-3).
(c) Family planning services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
11975
FP
30
B.R.
B.R.
N
11975
22
30
B.R.
B.R.
11976
FP
90
190.00
190.00
N
11977
22
90
B.R.
B.R.
11981
FP
100.00
100.00
11982
FP
100.00
100.00
11983
FP
180.00
180.00
36415
FP
3.40
3.40
36416
FP
1.80
1.80
54056
FP
32.00
32.00
3
N
55250
30
90.00
79.00
3
N
55450
30
42.00
37.00
3
56501
FP
29.00
29.00
3
56820
FP
30
88.00
NA
56821
FP
30
113.00
NA
57420
FP
71.00
NA
3
57421
FP
15
93.00
NA
3
57452
FP
39.90
39.90
3
57454
FP
64.60
64.60
3
57511
FP
45
45.60
45.60
3
58300
FP
30
74.10
74.10
3
58300
SA
						  FP
30
NA
29.85
3
58300
SB
						  FP
30
NA
29.85
3
58301
16.40
16.40
58301
FP
31.20
31.20
58301
SA
						  FP
NA
16.40
3
58301
SB FP
NA
16.40
81000
FP
1.20
1.20
81002
FP
1.00
1.00
81025
FP
3.00
3.00
82465
FP
3.00
3.00
82947
FP
4.34
4.34
82948
FP
1.50
1.50
85013
FP
1.50
1.50
85018
FP
2.00
2.00
86592
FP
1.50
1.50
86701
FP
12.00
12.00
86762
FP
12.00
12.00
87086
FP
6.00
6.00
87184
FP
9.00
9.00
87270
FP
10.00
10.00
87274
FP
12.80
12.80
87320
FP
12.50
12.50
87490
FP
20.00
20.00
87491
FP
38.00
38.00
87590
FP
25.00
25.00
87591
FP
38.00
38.00
87620
FP
25.00
25.00
87621
FP
38.00
38.00
88141
FP
6.00
6.00
88142
FP
18.00
18.00
88143
FP
18.00
18.00
88148
FP
13.48
13.48
88150
FP
6.00
6.00
88151
6.00
6.00
88152
FP
6.00
6.00
88153
FP
6.00
6.00
88154
FP
6.00
6.00
88164
FP
6.00
6.00
88165
FP
6.00
6.00
88166
FP
6.00
6.00
88167
FP
6.00
6.00
88305
FP
40.00
40.00
90471
FP
16.18
16.18
90649
FP
153.25
153.25
90671
FP
16.18
16.18
96372
FP
4.80
4.80
N
99201
FP
83.70
83.70
N
99201
FP
						  SB
NA
31.50
N
99201
FP
						  52
79.70
79.70
N
99202
FP
83.70
83.70
N
99202
FP
						  SB
NA
31.50
N
99202
FP
						  52
79.70
79.70
N
99203
FP
83.70
83.70
N
99203
FP
						  SB
NA
31.50
N
99203
FP
						  52
79.70
79.70
N
99204
FP
83.70
83.70
N
99204
FP
						  SB
NA
31.50
N
99204
FP
						  52
79.70
79.70
N
99205
FP
83.70
83.70
N
99205
FP
						  SB
NA
31.50
N
99205
FP
						  52
79.70
79.70
N
99211
FP
41.90
41.90
N
99211
FP
						  SB
NA
16.40
N
99211
FP
						  52
37.90
37.90
N
99212
FP
41.90
41.90
N
99212
FP
						  SB
NA
16.40
N
99212
FP
						  52
37.90
37.90
N
99213
FP
41.90
41.90
N
99213
FP
						  SB
NA
16.40
N
99213
FP
						  52
37.90
37.90
N
99214
FP
41.90
41.90
N
99214
FP
						  SB
NA
16.40
N
99214
FP
						  52
37.90
37.90
N
99215
FP
41.90
41.90
N
99215
FP
						  SB
NA
16.40
N
99215
FP
						  52
37.90
37.90
N
99395
FP
79.70
79.70
N
99395
FP
						  SB
NA
31.50
N
99395
FP
						  22
83.70
83.70
J0696
FP
12.97
12.97
J1055
FP
53.97
53.97
J1056
FP
22.60
22.60
J7300
FP
396.64
396.64
J7302
FP
450.88
450.88
J7303
FP
40.02
40.02
J7304
FP
15.72
15.72
J7307
FP
620.08
620.08
Q0111
FP
2.40
2.40
Y7633
FP
95.00
95.00
Y7634
FP
47.50
47.50
Z4333
FP
19.94
19.94
Z4334
FP
15.09
15.09
(d)
				Laboratory services (See N.J.A.C. 10:61-3).
(e) Minor surgery:
* An asterisk preceding any procedure code may also be
				  performed by a podiatrist.
Follow
Anes.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
N
10040
10
18.00
16.00
3
*
10060
10
13.00
11.00
3
*
10061
10
48.00
42.00
3
10080
10
30.00
26.00
3
*
10120
10
18.00
16.00
3
*
10121
10
34.00
29.00
3
*
10140
18.00
16.00
3
*
10160
13.00
11.00
3
*
11000
13.00
11.00
3
*
11001
6.00
5.00
3
*
11040
13.00
11.00
3
*
11041
13.00
11.00
3
*
11042
16.00
14.00
3
*
11043
16.00
14.00
3
*
11100
13.00
11.00
3
*
11400
10
18.00
16.00
3
*
11401
10
22.00
20.00
3
*
11402
10
27.00
24.00
3
*
11403
10
32.00
27.00
3
*
11404
10
32.00
27.00
3
*
11406
10
32.00
27.00
3
*
11420
10
18.00
16.00
3
*
11421
10
22.00
20.00
3
*
11422
10
27.00
24.00
3
*
11423
10
32.00
27.00
3
*
11424
10
32.00
27.00
3
*
11426
10
32.00
27.00
3
11440
10
18.00
16.00
5
11441
10
22.00
20.00
5
11442
10
27.00
24.00
5
11443
10
32.00
27.00
5
11444
10
32.00
27.00
5
11446
10
32.00
27.00
5
*
11600
10
37.00
32.00
3
*
11601
10
47.00
42.00
3
*
11602
10
61.00
53.00
3
*
11620
10
61.00
53.00
3
*
11621
10
90.00
79.00
3
*
11622
10
121.00
105.00
3
11640
10
90.00
79.00
5
11641
10
121.00
105.00
5
11642
10
150.00
131.00
5
*
11730
10.00
10.00
3
*
11750
10
42.00
37.00
3
*
12001
10
18.00
16.00
3
*
12002
10
24.00
21.00
3
*
12004
10
30.00
26.00
3
12005
10
46.00
39.00
3
12006
10
57.00
48.00
3
12007
10
82.50
70.00
3
12011
10
18.00
16.00
5
12013
10
24.00
21.00
5
12014
10
30.00
26.00
5
12031
10
30.00
26.00
3
12032
10
48.00
42.00
3
*
12041
10
30.00
26.00
3
*
12042
10
67.00
59.00
4
12051
10
38.00
33.00
4
12052
10
67.00
59.00
4
13100
10
34.00
29.00
4
13101
10
68.00
63.00
4
13120
10
48.00
42.00
4
13121
10
106.00
92.00
4
*
13131
10
67.00
59.00
4
*
13132
10
145.00
126.00
4
13150
10
38.00
33.00
4
13151
10
82.00
71.00
4
13152
10
193.00
168.00
4
*
17000
10
16.00
14.00
3
*
17110
10
16.00
14.00
3
20526
13.00
11.00
3
*
20550
13.00
11.00
5
*
20551
13.00
11.00
3
*
20552
13.00
11.00
3
*
20553
13.00
11.00
3
(f)
				Mental health services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
N
90801
UC
45.00
45.00
90804
UC
13.00
13.00
90805
UC
13.00
13.00
90806
UC
26.00
26.00
90807
UC
26.00
26.00
N
90847
UC
						  22
32.00
32.00
N
90853
UC
8.00
8.00
90862
UC
9.00
9.00
N
90887
UC
13.00
13.00
96101
UC
30.00
30.00
96102
UC
18.88
18.88
96103
UC
17.26
17.26
96105
UC
25.00
25.00
N
96150
UC
14.00
14.00
N
96151
UC
14.00
14.00
N
96152
UC
13.00
13.00
N
96153
UC
5.00
5.00
N
96154
UC
13.00
13.00
N
96155
UC
12.00
12.00
L
20100
22.50
22.50
L
Z0170
14.55
14.55
(g)
				Obstetrical services (maternity):
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
51798
16.00
13.00
59000
37.00
32.00
4
59001
47.00
40.00
4
N
59400
60
468.00
403.00
4
N
59400
SB
60
NA
328.00
4
59409
60
300.00
254.00
5
59409
SB
60
NA
210.00
5
N
59410
60
320.00
272.00
4
N
59410
SB
60
NA
224.00
4
59425
16.00
14.00
59425
SA
NA
13.30
59425
SB
NA
11.20
59426
16.00
14.00
59426
SA
NA
13.30
59426
SB
NA
11.20
N
59430
0
20.00
18.00
0
N
59430
SB
0
NA
14.00
0
59610
45
468.00
403.00
5
59610
SB
45
NA
328.00
5
59612
45
300.00
254.00
5
59612
SB
45
NA
210.00
5
59614
45
320.00
272.00
5
59614
SB
45
NA
224.00
5
59812
45
105.00
91.00
3
(h)
				Podiatry services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
29580
18.00
16.00
3
N
99211
16.00
14.00
N
99212
23.50
20.60
N
99213
23.50
20.60
N
99214
23.50
20.60
N
99215
23.50
20.60
NOTE:
See N.J.A.C. 10:66-6.2(f), Surgery, for
				  additional procedures.
(i)
				Radiology services:
Click here
				  to view table.
(j) Rehabilitation services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
N
92507
7.00
7.00
N
92552
11.00
11.00
N
92553
14.00
14.00
N
92557
19.00
19.00
92562
3.00
3.00
92563
3.00
3.00
92564
4.00
4.00
N
92567
5.00
5.00
N
92568
5.00
5.00
N
92572
3.50
3.50
N
92576
19.50
16.50
N
92582
14.00
14.00
92585
45.00
42.00
92590
40.00
34.00
92591
40.00
34.00
92620
34.15
29.03
92621
8.47
7.20
92625
33.94
28.84
97001
7.00
7.00
97002
7.00
7.00
97003
7.00
7.00
97004
7.00
7.00
N
97535
7.00
7.00
N
97799
7.00
7.00
Z0310
45.00
45.00
(k)
				Vision care services (See N.J.A.C. 10:62-4).
(l) Transportation services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
LN
A0425
UC
2.50
2.50
*N
36415
1.80
1.80
N
67221
90
283.00
241.00
N
67225
23.00
20.00
90746
65.25
65.25
93000
16.00
16.00
93005
11.00
11.00
93010
5.00
5.00
93012
11.00
9.00
93014
5.00
4.25
93015
80.00
68.00
93016
10.00
10.00
93017
35.00
35.00
93018
13.51
11.49
93268
32.00
27.00
93268
TC
19.00
19.00
93268
26
13.00
11.00
93270
17.00
14.00
93271
35.00
30.00
93272
20.00
17.00
96372
2.50
2.50
96373
9.47
8.05
96374
32.22
27.39
96401
36.09
30.68
96402
22.34
18.99
96405
16.00
14.00
96406
20.00
17.00
96409
66.57
56.58
96411
37.94
32.24
96413
90.24
76.70
96415
19.96
16.96
96416
98.05
83.34
96417
44.34
37.69
96420
16.00
14.00
96422
32.00
28.00
96423
16.00
14.00
96425
16.00
14.00
96440
38.00
32.00
96445
38.00
32.00
96450
61.00
52.00
96521
78.82
67.00
96522
62.77
53.35
96542
61.00
52.00
99173
5.00
5.00
N
99201
23.50
20.60
N
99201
SA
NA
19.60
N
99201
SB
NA
16.50
N
99202
23.50
20.60
N
99202
SA
NA
19.60
N
99202
SB
NA
16.50
N
99203
32.30
25.00
N
99203
SA
NA
23.80
N
99203
SB
NA
22.60
N
99203
UD
32.30
25.00
N
*99204
32.30
25.00
N
99204
SA
NA
23.80
N
99204
SB
NA
22.60
N
*99205
32.30
25.00
N
99211
16.00
14.00
N
99211
SA
NA
13.30
N
99211
SB
NA
11.20
N
99212
23.50
20.60
N
99212
SA
NA
19.60
N
99212
SB
NA
16.50
N
*99213
23.50
20.60
N
99213
SA
NA
19.60
N
99213
SB
NA
16.50
N
99213
UD
23.50
20.60
N
*99214
23.50
20.60
N
99214
SA
NA
19.60
N
99214
SB
NA
16.50
N
99215
23.50
20.60
99215
SA
NA
19.60
N
99215
SB
NA
16.50
99217
23.50
20.60
99221
32.30
25.00
99221
SA
NA
23.80
99221
SB
NA
22.60
99222
32.30
25.00
99223
32.30
25.00
99231
23.50
20.60
99231
SA
NA
19.60
99231
SB
NA
16.50
99232
23.50
20.60
99232
SA
NA
19.60
99232
SB
NA
16.50
99233
23.50
20.60
99234
55.90
47.00
99235
55.90
47.00
99236
55.90
47.00
99238
23.50
20.60
99239
23.50
20.60
N
99241
44.00
37.00
N
99242
64.70
54.40
N
99243
64.70
54.40
N
99244
91.10
77.90
99244
SM
73.50
62.50
99244
SN
73.50
62.50
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
99261
16.00
14.00
99262
23.50
20.60
99263
23.50
20.60
99281
16.00
14.00
99281
SA
NA
13.30
99282
23.50
20.60
99282
SA
NA
19.60
99283
23.50
20.60
99283
SA
NA
19.60
99284
32.30
25.00
99284
SA
NA
23.80
99285
32.30
25.00
N
99291
66.20
58.80
N
99292
33.10
29.40
N
99354
66.20
58.80
N
99354
SA
NA
55.90
N
99355
33.10
29.40
N
99355
SA
NA
27.90
99356
66.20
58.80
99357
33.10
29.40
99381
80.06
68.05
99381
22
80.06
68.05
99381
SA
NA
64.65
99381
EP SA
NA
64.65
99381
22 EP
80.06
68.05
99381
22 SA
NA
64.65
99382
86.53
73.55
99382
EP
86.53
73.55
99382
EP SA
NA
69.87
99382
22 EP
86.53
73.55
99382
SA
NA
69.87
99382
SA 52
NA
69.87
99382
22
86.53
73.55
99382
22 SA
NA
69.87
*99383
85.17
72.39
99383
EP
85.17
72.39
99383
SA
NA
68.77
99383
SA 52
NA
68.77
*99384
92.67
78.77
99384
EP
92.67
78.77
99384
SA
NA
74.83
99384
SA 52
NA
74.83
99384
SB
NA
64.87
*99385
32.30
25.00
99385
EP
92.67
78.77
99385
SA
NA
23.80
99385
SA 52
NA
23.80
99385
SB
NA
22.60
*99386
32.30
25.00
99386
SA
NA
23.80
99386
SB
NA
22.60
*99387
32.30
25.00
99387
SA
NA
23.80
99387
SB
NA
22.60
99391
64.05
54.44
99391
SA
NA
51.72
99391
EP
64.05
54.44
99391
22
64.05
54.44
99391
EP SA
NA
51.72
99391
22 EP
64.05
54.44
99392
71.54
60.81
99392
EP
71.54
60.81
99392
22
71.54
60.81
99392
SA
NA
51.72
99392
22 SA
NA
51.72
99392
EP SA
NA
51.72
99392
22 EP
71.54
60.81
99392
SA 52
NA
51.72
*99393
70.86
60.23
99393
SA
NA
57.22
99393
EP
70.86
60.23
99393
SA 52
NA
57.22
*99394
77.68
66.03
99394
EP
77.68
66.03
99394
SA
NA
62.73
99394
SA 52
NA
62.73
99394
SB
NA
54.38
*99395
32.30
25.00
99395
EP
78.36
66.61
99395
SA
NA
23.80
99395
SA 52
NA
23.80
99395
SB
NA
22.60
99396
32.30
25.00
99396
SA
NA
23.80
99396
SB
NA
22.60
*99397
32.30
25.00
99397
SA
NA
23.80
99397
SB
NA
22.60
99460
51.37
43.66
99460
SA
NA
41.48
99461
73.46
62.44
99463
69.22
58.83
99463
SA
NA
55.89
99464
65.14
55.37
99465
127.74
108.58
(m)
				Substance use disorder treatment facility services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
11975
FP
30
B.R.
B.R.
N
11975
22
30
B.R.
B.R.
11976
FP
90
190.00
190.00
N
11977
22
90
B.R.
B.R.
11981
FP
100.00
100.00
11982
FP
100.00
100.00
11983
FP
180.00
180.00
36415
FP
3.40
3.40
36416
FP
1.80
1.80
54056
FP
32.00
32.00
3
N
55250
30
90.00
79.00
3
N
55450
30
42.00
37.00
3
56501
FP
29.00
29.00
3
56820
FP
30
88.00
NA
56821
FP
30
113.00
NA
57420
FP
71.00
NA
3
57421
FP
15
93.00
NA
3
57452
FP
39.90
39.90
3
57454
FP
64.60
64.60
3
57511
FP
45
45.60
45.60
3
58300
FP
30
74.10
74.10
3
58300
SA
						  FP
30
NA
29.85
3
58300
SB
						  FP
30
NA
29.85
3
58301
16.40
16.40
58301
FP
31.20
31.20
58301
SA
						  FP
NA
16.40
3
58301
SB FP
NA
16.40
81000
FP
1.20
1.20
81002
FP
1.00
1.00
81025
FP
3.00
3.00
82465
FP
3.00
3.00
82947
FP
4.34
4.34
82948
FP
1.50
1.50
85013
FP
1.50
1.50
85018
FP
2.00
2.00
86592
FP
1.50
1.50
86701
FP
12.00
12.00
86762
FP
12.00
12.00
87086
FP
6.00
6.00
87184
FP
9.00
9.00
87270
FP
10.00
10.00
87274
FP
12.80
12.80
87320
FP
12.50
12.50
87490
FP
20.00
20.00
87491
FP
38.00
38.00
87590
FP
25.00
25.00
87591
FP
38.00
38.00
87620
FP
25.00
25.00
87621
FP
38.00
38.00
88141
FP
6.00
6.00
88142
FP
18.00
18.00
88143
FP
18.00
18.00
88148
FP
13.48
13.48
88150
FP
6.00
6.00
88151
6.00
6.00
88152
FP
6.00
6.00
88153
FP
6.00
6.00
88154
FP
6.00
6.00
88164
FP
6.00
6.00
88165
FP
6.00
6.00
88166
FP
6.00
6.00
88167
FP
6.00
6.00
88305
FP
40.00
40.00
90471
FP
16.18
16.18
90649
FP
153.25
153.25
90671
FP
16.18
16.18
96372
FP
4.80
4.80
N
99201
FP
83.70
83.70
N
99201
FP
						  SB
NA
31.50
N
99201
FP
						  52
79.70
79.70
N
99202
FP
83.70
83.70
N
99202
FP
						  SB
NA
31.50
N
99202
FP
						  52
79.70
79.70
N
99203
FP
83.70
83.70
N
99203
FP
						  SB
NA
31.50
N
99203
FP
						  52
79.70
79.70
N
99204
FP
83.70
83.70
N
99204
FP
						  SB
NA
31.50
N
99204
FP
						  52
79.70
79.70
N
99205
FP
83.70
83.70
N
99205
FP
						  SB
NA
31.50
N
99205
FP
						  52
79.70
79.70
N
99211
FP
41.90
41.90
N
99211
FP
						  SB
NA
16.40
N
99211
FP
						  52
37.90
37.90
N
99212
FP
41.90
41.90
N
99212
FP
						  SB
NA
16.40
N
99212
FP
						  52
37.90
37.90
N
99213
FP
41.90
41.90
N
99213
FP
						  SB
NA
16.40
N
99213
FP
						  52
37.90
37.90
N
99214
FP
41.90
41.90
N
99214
FP
						  SB
NA
16.40
N
99214
FP
						  52
37.90
37.90
N
99215
FP
41.90
41.90
N
99215
FP
						  SB
NA
16.40
N
99215
FP
						  52
37.90
37.90
N
99395
FP
79.70
79.70
N
99395
FP
						  SB
NA
31.50
N
99395
FP
						  22
83.70
83.70
J0696
FP
12.97
12.97
J1055
FP
53.97
53.97
J1056
FP
22.60
22.60
J7300
FP
396.64
396.64
J7302
FP
450.88
450.88
J7303
FP
40.02
40.02
J7304
FP
15.72
15.72
J7307
FP
620.08
620.08
Q0111
FP
2.40
2.40
Y7633
FP
95.00
95.00
Y7634
FP
47.50
47.50
Z4333
FP
19.94
19.94
Z4334
FP
15.09
15.09
(n)
				Federally qualified health care services:
Follow
Anes.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
L
W9840
contract
contract
W9843
contract
contract
L
D0120
22
contract
contract
T1015
contract
contract
T1015
EP
contract
contract
T1015
HD
contract
contract
L
T1015
HE
contract
contract
(o)
				Personal care assistant services:
Follow
Maximum Fee
Anes.
HCPCS
Up
Allowance
Basic
Ind
Code
Mod
Days
S
$
NS
Units
L
Z1600
UC
13.02
13.02
L
Z1605
UC
10.23
10.23
L
Z1610
UC
35.00
35.00
L
Z1611
UC
6.51
6.51
L
Z1612
UC
5.12
5.12
L
Z1613
UC
35.00
35.00
(p)
				Vaccine for Children Program Administration Codes:
Ind
HCPCS Code
Maximum Fee Allowance
N
90465
16.18
N
90466
11.50
N
90467
11.44
N
90468
8.77
N
90471
16.18
N
90472
11.50
N
90473
12.12
N
90474
8.43
(q)
				Immunizations
HCPCS
Ind
Code
Maximum Fee Allowance
N
++
90632
80.95
N
++
90632
80.95
++
90633
38.24
N
90636
103.04
++
90647
31.52
++
90648
29.54
N
90649
153.25
++
90655
19.33
++
90656
20.64
++
90657
9.41
++
90658
17.56
++
90660
25.69
90665
B.R.
++
90669
94.62
90675
B.R.
++
90680
88.64
90681
130.44
90691
79.90
++
90696
61.75
++
90698
92.70
++
90700
28.68
90702
31.56
90703
17.72
90704
29.08
90705
24.21
90706
25.37
++
90707
56.96
++
90713
33.03
++
90714
26.05
++
90715
47.25
++
90716
98.27
90717
81.35
++
90718
17.50
++
90721
55.35
++
90723
90.90
N
++
90732
35.76
90733
115.18
N
++
90734
114.10
90736
188.66
90740
209.86
++
90743
74.28
++
90744
29.62
N
++
90746
65.25
N
++
90748
56.20
90749
B.R.
"++" Indicates that this vaccine is covered under the VFC
				  Program. Providers must report both the appropriate VFC administration code and
				  the associated HCPCS procedure code when requesting payment for the
				  administration fee(s) for VFC vaccines to ensure appropriate reimbursement is
				  provided. (See
				  N.J.A.C.
				  10:66-2.20.)
(r) Miscellaneous services:
Follow
Anes
.
HCPCS
Up
Maximum
Fee
Basic
Allowance
Ind
Code
Mod
Days
S
$
NS
Units
58120
15
72.00
63.00
3
N
59840
45
79.00
68.00
3
N
59841
45
79.00
68.00
3