NJ PIP Fee Schedule Lookup: All Seven Official Exhibits
This free New Jersey PIP fee schedule lookup carries all 7,553 rows of the seven exhibits adopted under N.J.A.C. 11:3-29. Paste the codes from a bill and get the physicians’, ASC, hospital outpatient, equipment, dental, home care and ambulance amounts for North and South New Jersey. No sign-up, no daily limit.
Paste a bill’s codes, price them against all seven exhibits
Amounts are the maximum reimbursable under the New Jersey PIP fee schedule, effective for treatment rendered on or after January 4, 2013, and are the lesser of the provider’s charge or the scheduled amount. They are not what was billed and not what was paid. For Medicare benchmarks on the same codes, use the free Medicare rate lookup.
The whole schedule as one file. All seven exhibits merged into a single CSV, 7,553 rows with an exhibit column. No email, no sign-up.
Download the CSVThe seven exhibits, published in full
Each exhibit has its own page carrying every row in plain HTML, so an amount can be read, searched, cited and linked without opening a spreadsheet.
Physicians' and ASC Facility Fee Schedule
The physician's fee and the ambulatory surgery center facility fee for each code, North and South, with the ASC payment indicators.
2,910 rowsExhibit 7Hospital Outpatient Surgical Facility Fee Schedule
The facility fee a hospital outpatient surgical facility may be paid for a surgical procedure, North and South.
1,263 rowsExhibit 5Durable Medical Equipment, Prosthetics, Orthotics and Supplies
One statewide retail price per code and modifier: purchase new, purchase used, or monthly rental.
2,991 rowsExhibit 2Dental Fee Schedule
CDT codes, North and South, for dental treatment after an automobile accident.
323 rowsExhibit 6CPT Codes Subject to the $105 Daily Maximum
The physical medicine and rehabilitation codes that share one $105 ceiling per day, across every provider.
48 rowsExhibit 3Home Care Services
Private nursing care per hour and home health visits per visit, one statewide fee each.
9 rowsExhibit 4Ambulance Services
Ground and rotary wing transport plus the two mileage codes, North and South.
9 rowsWhat decides the number on a New Jersey PIP bill
What is the New Jersey PIP fee schedule?
It is the price list New Jersey imposes on medical treatment paid by automobile personal injury protection coverage. Adopted as N.J.A.C. 11:3-29 and published by the Department of Banking and Insurance, it is effective for treatment rendered on or after January 4, 2013and has not been amended since. Reimbursement is the lesser of the provider’s charge or the scheduled amount.
The schedule caps the whole charge, not just the insurer’s share. 11:3-29.6 prohibits balance billing outright: a provider may not demand payment from anyone in excess of what the schedule permits, and no person is liable for an amount that results from charging above it. That single sentence is why the numbers on these pages matter to a patient as well as to a carrier.
Which region prices the bill?
The region where the service was rendered, chosen by ZIP code. 11:3-29.3(a) puts Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Monmouth, Ocean and Salem counties in the South region and Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, Passaic, Somerset, Sussex, Union and Warren counties in the North, then lists the three-digit ZIP prefixes for each and splits the 085 range one ZIP at a time.
Two things about that list are worth knowing before relying on it. Some 085 values appear in neither region, so the honest answer for those ZIP codes is that the regulation does not name one, which is what the tool above returns. And residence decides the region in exactly one case: 11:3-29.4(d)2 prices elective care given outside New Jersey under the schedule for the region the insured lives in, while emergency or medically necessary care outside the State is priced at the usual and customary fee for the provider’s own location.
What does an empty cell mean?
It depends on the column, and on Exhibit 1 the two meanings are opposite. An empty ASC facility fee means the facility fee is not reimbursable in an ambulatory surgery center (11:3-29.5(a), 29.4(e)3). An empty physicians’ fee means the service is still reimbursable, priced under 11:3-29.4(e), which FAQ Answer 5 states outright.
FAQ Answer 6 closes by saying that 29.5(a) and 29.4(e)3 apply only to facility fees and do not apply to physician services. A third state exists on the same exhibit: the payment indicator N1 marks a service that may be performed in an ASC but whose facility fee is packaged into another procedure rather than paid separately.
- N1
- ASC packaged procedure, no separate payment. The service may be performed in an ASC but its facility fee is not separately reimbursable, because it is included in another procedure (FAQ Answer 6).
- X
- ASC code not subject to multiple procedure reductions (29.5(d)2).
- X, N1
- Both of the above apply to the row.
Is the $105 daily maximum per provider?
No. FAQ Answer 10 says the $105 limit on the Exhibit 6 codes applies regardless of the number of providers the injured person visits, so it is one ceiling per day for the patient, not one per practice. 11:3-29.4(m) adds that it applies to all providers, including dentists.
Nor is it absolute. The same subsection continues: where the provider can demonstrate that the severity or extent of the injury is such that extraordinary time and effort is needed for effective treatment, the insurer shall reimburse in excess of the daily maximum. Those bills carry modifier 22 and documentation of why. FAQ Answer 11 gives the arithmetic, and it compares against the provider’s own usual and customary fees rather than against schedule amounts, which is why Exhibit 6 carries no fee column and why no honest tool built from the published file can total a capped day for you.
The eight crosswalks the Department publishes itself
When CPT renames a procedure, the new code is not on a schedule adopted in 2012. FAQ Answer 7 publishes the Department’s own mapping for that case, and prices the new code at the old code’s fee.
| Billed code | Priced as |
|---|---|
| 62320 | 62310 |
| 62321 | 62310 |
| 62322 | 62311 |
| 62323 | 62311 |
| 64635 | 64622 |
| 64636 | 64623 |
| 64633 | 64626 |
| 64634 | 64627 |
Read the scope, not just the pairs. The Department publishes these as crosswalked codes for the ASC facility fee column of Exhibit 1. They price a facility fee, and the FAQ does not extend them to the physicians’ column. The Department also invites providers to bring other renamed codes to it, and says a code can be crosswalked where the new code describes substantially the same service and Medicare still permits it in an ASC.
This page publishes the State’s eight and nothing else. Crosswalks we maintain ourselves are our reading of the rule rather than the Department’s, and a page whose whole premise is that every figure traces to the official file is the wrong place for them.
Codes the regulation singles out by name
A fee next to a code is not permission to bill it. These are the codes N.J.A.C. 11:3-29 names in its own text, with the subsection that does it.
| Codes | Status | What the rule says | Cite |
|---|---|---|---|
| 97010 | not reimbursable | CPT 97010, application of hot or cold packs, is bundled into the payment for other services and is not separately reimbursable. FAQ Answer 13 adds that it may still be shown on the bill or the list of treatments. That answer cites (g)1; the rule text puts it at (g)2. | 11:3-29.4(g)2 |
| 76499 | not reimbursable | X-ray digitization and computer aided radiographic mensuration are not reimbursable under PIP, whether reported under CPT 76499 or any other code. | 11:3-29.4(g)3 |
| 76140 | not reimbursable | CPT 76140 is not reimbursable. Reviewing the report of an imaging study is already inside the eligible charge for an office visit when the provider of the study billed both components. A provider in a different practice who performs a medically necessary review and writes a report as part of a consultation bills the professional component (-26) of the specific radiology service instead. | 11:3-29.4(g)7 |
| 29200 to 29280, 29520 to 29590 | not reimbursable | Kinesio taping and other taping is not reimbursable under PIP, and may not be billed using the strapping codes CPT 29200 through 29280 and 29520 through 29590. | 11:3-29.4(g)4 |
| 99143, 99144, 99145 | not reimbursable | Moderate (conscious) sedation performed by the same physician who furnishes the medical or surgical service is bundled into that service for the procedures listed in Appendix G of the CPT manual, so CPT 99143 through 99145 are not reimbursable for them. | 11:3-29.4(g)11 |
| 99148, 99149, 99150 | conditional | CPT 99148 through 99150 are reimbursable only where a second physician provides moderate sedation in a facility setting, such as a hospital, an outpatient hospital or ambulatory surgery center, or a skilled nursing facility. They are not reimbursable in a physician office or a freestanding imaging center, nor for any procedure CPT already identifies as including moderate sedation. | 11:3-29.4(g)12 |
| 0232T | conditional | Platelet Rich Plasma injections are reimbursable only for chronically injured tendons that have failed to improve despite appropriate conservative treatment, and must be billed under code 0232T. | 11:3-29.4(g)5 |
| 77003 | conditional | Where CPT 77003, fluoroscopic guidance, is separately billable and not included in another procedure, it is reimbursable per spinal region, not per level. | 11:3-29.4(g)8 |
| 22505 | conditional | CPT 22505, manipulation of spine requiring anesthesia, can be reported only once for all regions manipulated on a date of service. | 11:3-29.4(g)13 |
| G0289 | conditional | HCPCS G0289 is an add-on to the knee arthroscopy code for the main procedure, reported once per extra compartment and only where the physician spent at least 15 minutes in that compartment. It may be reported twice where two extra compartments were treated. It is not reportable where the reason was a problem the arthroscopy itself caused, and CPT 29874 may not be used to report what G0289 describes. | 11:3-29.4(g)9 |
| 97012 | code fixed by rule | CPT 97012 is the only code for powered traction therapy. FAQ Answer 17 adds that the insurer need only evaluate medical necessity, whatever code a precertification request carried. | 11:3-29.4(m)2 |
| 97026 | code fixed by rule | CPT 97026 is the code for cold or low-powered laser therapy. | 11:3-29.4(m)3 |
| G0283 | code fixed by rule | HCPCS G0283 is the code for unattended electrical stimulation. | 11:3-29.4(m)4 |
| 95900, 95903, 95904 | conditional | Nerve conduction studies are reimbursable only where the interpreting provider was on site and directly supervised or performed the study. Needle EMG interpretation must happen in the same facility, on the same day, by the physician who performed or supervised it. | 11:3-29.4(h) |
| 64999 | conditional | Unlisted procedure and unlisted service codes are not reimbursable without documentation describing what was performed, showing it was medically appropriate, and saying why it is not covered by a listed code. It is never appropriate to bill an unlisted code for a set of services that do have codes. | 11:3-29.4(k) |
What each modifier does, and where it stops
Scope is the part that gets lost. The multiple procedure reduction reaches the physicians’ column and CPT 10000 to 69999 only. Facility fees have their own rule, and the daily maximum codes are outside both.
| Modifier | Name | Applies to | What the rule says | Cite |
|---|---|---|---|---|
| -51 | Multiple procedures | Physicians' fee column only, CPT 10000 to 69999 | Rank the surgical procedures in descending order of fee. The highest is reimbursed at 100 percent of the eligible charge; each additional procedure is reported with -51 and reimbursed at 50 percent. FAQ Answer 12 says this does not reach diagnostic testing such as MRI or X-ray, because the subsection covers multiple and bilateral surgeries only. Codes CPT marks “Modifier -51 exempt” and add-on codes reading “each additional” or “list separately in addition to the primary procedure” stay at 100 percent. | 11:3-29.4(f)1, FAQ 12 |
| -50 | Bilateral surgery | Physicians' fee column only, CPT 10000 to 69999 | A procedure performed on the same site on both sides, each through its own incision, is reported as a single line item with -50 and reimbursed at 150 percent of the eligible charge, ranked as one payment amount against the other procedures. The exception cancels it outright: the bilateral adjustment does not apply where CPT already describes the procedure as “bilateral” or “unilateral or bilateral”, because the listed fee already reflects that work. | 11:3-29.4(f)1, (f)3 |
| -62 | Co-surgeons | Physicians' fee column | Two surgeons in different specialties, each billing the procedure with -62, are each paid 62.5 percent of the eligible charge. | 11:3-29.4(f)4 |
| -80 -81 -82 | Assistant surgeon | Physicians' fee column | An assistant surgeon's eligible charge is 20 percent of the primary physician's allowable fee. Necessity is judged against authorities such as the Medicare physician fee schedule database; a facility's own policy that an assistant be present does not make one reimbursable. | 11:3-29.4(f)5 |
| -AS | Non-physician assistant | Physicians' fee column | Where the assistant surgeon is not a physician surgeon, reimbursement is capped at 85 percent of what a physician surgeon would have been paid, reported with -AS. | 11:3-29.4(f)5 |
| -22 | Unusual procedural services | The $105 daily maximum | The daily maximum is not absolute. Where the provider can show the severity or extent of the injury needed extraordinary time and effort for effective treatment, the insurer shall reimburse in excess of it. Those bills carry -22 and documentation of why. The rule names severe brain injury and non-soft-tissue injuries to more than one part of the body as examples, and excludes diagnoses with a care path under N.J.A.C. 11:3-4. | 11:3-29.4(m) |
| -TS | Trauma services | Level I and Level II trauma hospitals | The physicians' fees in Exhibit 1, the multiple and bilateral surgery provisions, and the facility fees in Exhibit 7 do not apply to trauma services at a Level I or Level II trauma hospital. Those bills carry -TS. “Trauma services” means care given to a patient whose arrival required trauma center activation, not transport, not a patient who arrived without activation, and not outpatient visits after discharge from acute care. | 11:3-29.4(a)1 |
| -ER | Emergency room | Two separate rules, both marked -ER | Exhibit 7 facility fees do not apply at all to services provided in a hospital emergency room. Separately, physician services in CPT 10000 to 69999 given as emergency care in an acute care hospital, where the trauma exemption does not apply, are reimbursed at 150 percent of the Exhibit 1 physicians' fee. Both are billed with -ER. | 11:3-29.4(a)2, (a)3 |
| -26 -TC | Professional and technical components | Physicians' fee column | Some codes appear three times: a global fee with no modifier, a technical component with -TC, and a professional component with -26. A provider may not bill the global fee and a component. A component is billed when only that part of the service was provided. Where the professional component is zero, the service is treated as 100 percent technical. | 11:3-29.4(l), FAQ 14 |
| -NU -UE -RR | Equipment purchased, used or rented | Exhibit 5, durable medical equipment | Exhibit 5 fees are retail prices covering new purchase, used purchase and monthly rental. New equipment is marked -NU, used -UE and rental -RR. The insurer's total liability for renting one item is 15 times the monthly rental fee or the purchase price, whichever is less. | 11:3-29.4(c), (c)1 |
| -25 | Separately identifiable evaluation | Physical medicine and rehabilitation | A follow-up evaluation and management service for re-examining an established patient is reimbursable on top of physical medicine and rehabilitation procedures only in four listed circumstances, and not more than twice in any 30 day period. It carries -25 and has to be documented as medically necessary. | 11:3-29.4(n) |
Two of these cannot be turned into a number from published data, and this page does not pretend otherwise. Modifier 50 does not apply to a procedure CPT already describes as bilateral or as unilateral or bilateral, because the listed fee already covers that work (11:3-29.4(f)3). Which codes those are lives in the AMA’s long descriptor text, which is not part of the published schedule. And the $105 daily maximum is measured against the provider’s own usual and customary fees, which are not published anywhere.
Why there is no UCR column on this page
Because usual, customary and reasonable is not published data, and anyone offering it free is either quoting a schedule amount and calling it UCR or republishing something licensed. The fee schedule is state law. UCR is not.
11:3-29.4(e)1 says how UCR is actually determined under New Jersey PIP. The provider submits their usual and customary fee by means of explanations of benefits from payors showing what they billed and what they were paid. The insurer then tests reasonableness against its own experience with that provider and with other providers in the region. National fee databases, and the rule names FAIR Health and Wasserman as examples, are evidence of reasonableness rather than the answer itself, and an insurer relying on one has to identify the database, the edition date, the geozip and the percentile it used.
Those databases are licensed products. We hold licensed benchmark data and are not permitted to republish it, so this page carries the part that is public and says plainly what it is leaving out. Where a New Jersey PIP claim needs both halves resolved together, our NJFS and UCR lookup does that for a client team on its own infrastructure. For the Medicare benchmark on the same codes, which is also public, the free Medicare rate lookup prices any CPT or HCPCS code by state.
Where every number on this page came from
Source & method
- The schedule: N.J.A.C. 11:3-29, adopted November 5, 2012, effective for treatment rendered on or after January 4, 2013, published by the New Jersey Department of Banking and Insurance on its auto medical fee schedule page.
- The rule text: the full text of the fee schedule rule, which is where every subsection cited on this page can be read in context.
- The Department’s own FAQ: 21 questions the Department answers itself, last updated January 16, 2020, and the source of the eight crosswalks above.
- The February 2019 correction: the Department replaced Exhibit 1 because its posted files had omitted the X and N1 payment indicators for 17 CPT codes, and warned that certain third-party legal research tools still carry the omission. These pages are built from the corrected file.
- How this page is built: the Department’s Excel files are parsed directly, with the row count of every exhibit pinned as a build-time assertion and every figure cross-checked against the Department’s PDF of the same exhibit. Any unrecognised row stops the build rather than shipping.
- Download: all seven exhibits merged into one CSV, 7,553 rows, free and ungated.
The New Jersey PIP fee schedule, answered
Is the New Jersey PIP fee schedule public?
Yes. It is state law, adopted as N.J.A.C. 11:3-29 and published by the New Jersey Department of Banking and Insurance as seven exhibits in Excel and PDF. The amounts are freely readable and freely republishable, which is why this page carries all 7,553 rows rather than a sample. The procedure descriptions beside them are the short descriptors the State printed, and the AMA and ADA notices that travel with them are reproduced here.
When was the New Jersey PIP fee schedule last updated?
The current schedule was adopted on November 5, 2012 and is effective for treatment rendered on or after January 4, 2013. It has not been amended since. One correction was issued: on February 20, 2019 the Department replaced Exhibit 1 because its posted files had omitted the X and N1 payment indicators for 17 CPT codes. The files behind this page are the corrected ones.
Is the $105 daily maximum per provider or per day?
Per day, across every provider. FAQ Answer 10 from the Department says the $105 limit applies regardless of the number of providers the injured person visits, so two practices treating the same patient on the same day share one $105 rather than getting one each. The cap is not absolute: 11:3-29.4(m) says an insurer shall reimburse above it where the provider demonstrates that the injury needed extraordinary time and effort, billed with modifier 22 and documented.
How are the North and South New Jersey regions decided?
By the ZIP code where the service was rendered, not where the patient lives. 11:3-29.3(a) lists the three-digit prefixes for each region and then splits the 085 range one ZIP code at a time. Some 085 values appear in neither list, and this page says so rather than guessing. The one case where the patient's address decides is elective care given outside New Jersey, which 11:3-29.4(d)2 prices under the region the insured lives in.
What happens when a procedure code is not on the schedule?
It is still reimbursable. 11:3-29.4(e) prices a service the schedule does not carry at a reasonable amount, considering the fee schedule amount for similar services in the same region, and where the schedule holds nothing similar, at the usual, customary and reasonable fee. The single exception is a facility fee in an ambulatory surgery center: 11:3-29.5(a) and 29.4(e)3 make an ASC facility fee with no listed amount not reimbursable, and FAQ Answer 6 says that exception reaches facility fees only, never physician services.
Can a provider bill the patient the difference?
No. 11:3-29.6 prohibits balance billing outright: no health care provider may demand or request any payment from any person in excess of what the fee schedules and the subchapter permit, and no person is liable for an amount that results from charging above them. The schedule is a ceiling on the whole charge, not only on the insurer's share of it.
Does this lookup include UCR or fair and reasonable amounts?
No, and nothing free can. Usual, customary and reasonable is not published data. 11:3-29.4(e)1 builds it from the provider's own explanations of benefits and the insurer's experience in the region, and names FAIR Health and Wasserman as examples of national fee databases that are evidence of it. Those databases are licensed and cannot be republished. This page carries the fee schedule, which is state law and free, and says so instead of blending the two.
How do I download the whole New Jersey PIP fee schedule?
Two ways. The Department publishes the seven exhibits one file at a time on its auto medical fee schedule page, as Excel and PDF. This page also offers all seven merged into a single CSV of 7,553 rows, with an exhibit column so the rows stay distinguishable. It is free, needs no email address, and is built by the same parse that renders the tables on these pages.
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