PIP ALERT

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