Attention Medical Providers:
The following PIP ALERT was discussed at last nights Meeting of the NJASIPP.
This information is prepared by Massood & Bronsnick, LLC.
NEW PIP REGULATIONS EFFECTIVE JANUARY 2013
The new PIP regulations become effective approximately January 3, 2013. The new regulations affect all medical providers but the substantial changes are to surgical centers, pain management physicians, surgeons, VNG testing, and acupuncturists. (New appeal Process goes into effect January 3, 2014)
NEW FEE SCHEDULE
The New Fee Schedule provides substantially less reimbursement and does not permit reimbursement for numerous codes (included with other procedures.) Reimbursement rates are not addressed in this memo.
A. Exhibit 1, Physicians in Surgical Centers
B. Exhibit 2, Dental fee schedule
C. Exhibit 3, Home care fee schedule
D. Exhibit 4, Ambulatory Service Fee Schedule
E. Exhibit 5, Durable Medical Equipment Fee Schedule
F. Exhibit 6, Codes Subject to Daily Maximum
G. Exhibit 7, HOSF Schedule
AMBULATORY SURGICAL CENTER
New Definition: ambulatory surgical; case means a procedure that is not minor surgery that is defined in N.J.A.C. 13:35-4A-.3. N.J.A.C. 13:35-4A-.3 states:
Codes that do not appear in Exhibit 1 are not reimbursable in an ASC.
DISCOGRAPHY
CPT Codes 62290 and 62291 are not reimbursable if performed at an ASC or an out- patient hospital. CPT 62290 and 62291 are listed in the July 2011, Exhibit 1. They have an amount for the physician, but not for a surgical center. The discography codes have been removed from the January 2012 Exhibit 1 and the October 2012 Exhibit 1. The discography codes also appear on Exhibit 7 Hospital Out-Patient with no amount. Commissioner’s October 2012 comments, page 299, states discography performed at an ASC or Out-Patient Hospitals are not entitled to reimbursement.
| There are 129 medical procedures that are no longer reimbursable if performed in an ASC. They are as follows: CODE | CODE |
CODE |
CODE |
CODE |
|||
| 20100 | 20101 | 20102 | 20660 | 20661 | |||
| 20664 | 20931 | 20937 | 20938 | 20955 | |||
| 20974 | 20975 | 20985 | 21116 | 21365 | |||
| 21366 | 21385 | 21386 | 21395 | 21408 | |||
| 21470 | 21825 | 22220 | 22222 | 22224 | |||
| 22226 | 22318 | 22319 | 22325 | 22326 | |||
| 22327 | 22328 | 22520 | 22521 | 22522 | |||
| 22526 | 22527 | 22532 | 22533 | 22534 | |||
| 22548 | 22551 | 22552 | 22554 | 22556 | |||
| 22558 | 22585 | 22590 | 22595 | 22600 | |||
| 22610 | 22612 | 22614 | 22630 | 22632 | |||
| 22800 | 22802 | 22804 | 22808 | 22810 | |||
| 22812 | 22830 | 22840 | 22842 | 22843 | |||
| 22844 | 22845 | 00846 | 00847 | 22848 | |||
| 22849 | 22850 | 22851 | 22852 | 22855 | |||
| 22856 | 22857 | 23332 | 23350 | 23470 | |||
| 23472 | 24220 | 25246 | 26055 | 27036 | |||
| 27093 | 27095 | 27096 | 27130 | 27132 | |||
| 27227 | 27228 | 27236 | 27245 | 27447 | |||
| 27487 | 27506 | 27507 | 27511 | 27513 | |||
| 27514 | 27524 | 27535 | 27536 | 27540 | |||
| 61107 | 61154 | 61312 | 61313 | 63020 | |||
| 63030 | 63035 | 63040 | 63042 | 63044 | |||
| 63054 | 63046 | 63047 | 63048 | 63050 | |||
| 63051 | 63056 | 63057 | 63075 | 63076 | |||
| 63077 | 63078 | 63081 | 63082 | ||||
