New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 62 - VISION CARE SERVICES MANUAL › Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) › Section 10:62-3.4 - Qualifier for professional vision care services

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Qualifiers for professional vision care services are summarized below:
HCPCS
Procedure
Codes
1.
				COMPREHENSIVE EYE EXAMINATION
92002
Comprehensive Eye Examination--Refers to
						  a
92004
new or established patient.
92012
92014
2.
				COMPREHENSIVE EYE EXAMINATION WITH DIAGNOSTIC FIELDS
92004
22
Comprehensive Eye Examination
						  with Diagnostic
92014
22
Fields--Refers to a new or
						  established patient.
3.
				INDEPENDENT OFFICE PROCEDURES
92020
Independent Office
						  Procedures--HCPCS
92065
92020, 92065, 92081, 92082, 92083,
						  92100,
92081
92120, 92130, 92140, 92260,
92082
shall notbereimbursable
92083
when performedonthe same day as
						  HCPCS
92100
92002, 92004, 92012 or 92014.
92120
92130
92140
92260
4.
				OFFICE SERVICES (NEW PATIENT)
Codes 99201, 99202, 99203, 99204, 99205, 99301, 99302, 99303,
				  99321, 99322 and 99323 shall not be reimbursable with 92002, 92004, 92012 or
				  92014 on the same day.
5.
				OFFICE SERVICES (ESTABLISHED PATIENT)
Codes 99211, 99212, 99213, 99214, 99215, 99311, 99312 and
				  99313 shall not be reimbursable with 92002, 92004, 92012 or 92014 on the same
				  day.
6. EMERGENCY
				DEPARTMENT SERVICES
Physician's Use of Emergency Room Instead of Office:
99211
When a physician sees his/her patient in
						  the emer-
99212
gency room instead of his/her office, the
						  physician
99213
shall use the same HCPCS for the visit
						  that would
99214
have been used if seen in the physician's
						  office
99215
(99211, 99212, 99213, 99214 or 99215
						  only).
Hospital-Based Emergency Room Physicians:
99281
When patients are seen by hospital-based
						  emer-
99282
gency room physicians who are eligible to
						  bill the
99283
Medicaid/NJ FamilyCare program, then the
						  ap-
99284
propriate HCPCS is used. The "Visit"
						  codes shall
99285
be limited to 99281, 99282, 99283, 99284
						  and 99285.
7.
				BRAIN-STEM-EVOKED RESPONSE TESTING
92280
Not reimbursable for initial testing,
						  general screening, research
studies or any situation where usefulness has not been
						  clearly
established; and therefore, it is without
						  controversy.
Code 92280--for reimbursement purposes refers to a
						  visual
brain-stem-evoked response (VBR) with interpretation.
						  Reimbursable
to hospital outpatient department as a hospital charge
						  or to a
qualified provider (office setting). The study must be
						  personally
performed by any of the following disciplines trained
						  and
experienced with VBR testing, namely Ophthalmologists,
						  Optometrists,
Neurologists, Neurosurgeons, and Psychiatrists.
						  Criteria for
testing:
i.
Inconclusive test results by standard vision
						  testing for:
(1)
Neonates and infants at risk for vision
						  loss;
(2)
Children and adults who cannot perform
						  behavioral testing.
ii.
Suspected organic neurologic lesion within
						  or proximal to the
visual pathway.
8.
				UNUSUAL TRAVEL, FOR EXAMPLE, TRANSPORTATION AND ESCORT OF PATIENT
Code 99082 may be used for travel costs only associated and
				  billed with HOUSE CALL OR HOME VISIT. (See HCPCS 99341, 99342, 99343, 99347,
				  99348 and 99349.)
9. HOME
				SERVICES
Home Visit--99343 and 99349
The Home Visit HCPCS 99343 and 99349 does not
						  distinguish
between specialist and non-specialist. These codes
						  shall not
apply to residential health care facility or nursing
						  facility
settings. These codes refer to a physician visit
						  limited to the
provision of medical care to an individual who would be
						  too ill
to go to a physician's office and/or is "home bound"
						  due to
his/her physical condition. When billing for a second
						  or
subsequent patient treated during the same visit, the
						  visit
should be billed as a home visit.
Home Visit--99341, 99342, 99344, 99345, 99347, 99348
						  and 99349
These HCPCS apply when the provider visits a
						  beneficiary in the
home and the visit does not meet the criteria specified
						  under a
House Call listed in
						  10:62-1.13.