Wiki New Jersey pip fee sched ???

[jennburgel]

I work for an ASC. Has anyone been paid in NJ according to the new pip fee schedule ror 2013? We are having a hard time deciphering the primary vs secondary procedures. Fee sched reads for example 64490 =$ 931.80 which is the primary code 64491= $ 327.00 for the secondary. They are paying 1/2 for the secondary procudre ie: 163.50. Why do they give a fee for 64491 and 64492 when they are add on codes and cannot be billed without 64490. Help !!! We just want to know how to expect to be paid so we can bill accordingly.

 

[ChelleLeigh]

I'm not sure if this will actually help you or not, but I am a PIP paralegal in NJ (also studying for CPC exam at the same time) so I don't have experience with what is paid on these currently and we haven't actually received arbs yet with the new fee schedule (too soon), however, that being said..... I have read over the new fee schedule several times and this is my understanding of it.....

The procedure with the highest payment amount is reimbursed at 100%
Reimbursement of any additional procedures in the same session is 50%
Bilateral procedures are reported as 2 procedures and subject to multiple reduction (100% + 50%)
If the fee schedule lists an "X" in the indicator column it is not subject to multiple reduction
If the fee schedule lists "N1" there is no separate payment

All that being said, I would expect payment for 64490 and 64491 per the south region to be as follows:
64490 = $931.80
64491 = $163.83 (50% since the "x" is not listed)

I personally think the multiple reduction makes no sense since it is an add on code, but this is how I read it. Again, we haven't actually arbitrated any of these yet so perhaps there will be a different result. Perhaps you can also contact your arb attorney for further clarification of this?

If you have any arb questions that I may be able to help you with, let me know!