NJ PIP Fee Schedule Exhibit 3: Home Care Services
Exhibit 3 is the shortest of the seven schedules and the one most easily misread. Its nine rows split into two blocks with different billing units: private nursing care is paid per hour, home health visits per visit. A registered nurse therefore appears twice, at $70 and at $125, under two different codes.
Exhibit 3 in full, all 9 rows
How to read this table
- Unit
- Which block the row sits in. Per hour is private nursing care; per visit is a home health visit. The amounts are not comparable across the two.
- Code
- The HCPCS code. The same service in the two blocks carries different codes, which is what keeps the two rates apart on a bill.
- Fee
- One statewide amount. Exhibit 3 has no North and South columns, and 11:3-29.3(a) does not define regions for it.
Private nursing care, per hour
4 rows| Service | Code | Unit | Fee |
|---|---|---|---|
| Registered Nurse | S9123 | per hour | $70.00 |
| Licensed Practical Nurse | S9124 | per hour | $65.00 |
| Home Health Aide | S9122 | per hour | $24.00 |
| Live-in Attendant (per 24 hr shift | S5126 | per hour | $180.00 |
Home health visits, per visit
5 rows| Service | Code | Unit | Fee |
|---|---|---|---|
| Registered Nurse | T1030 | per visit | $125.00 |
| Physical Therapist | S9131 | per visit | $135.00 |
| Speech Therapist | S9128 | per visit | $145.00 |
| Occupational Therapist | S9129 | per visit | $135.00 |
| Medical Social Worker | S9127 | per visit | $195.00 |
Source
- The schedule: N.J.A.C. 11:3-29 Appendix, Exhibit 3, published by the New Jersey Department of Banking and Insurance and effective for treatment rendered on or after January 4, 2013. It has not been amended since.
- Official files: the Department’s auto medical fee schedule page, the rule text and the Department’s own FAQ.
- This page: parsed from the Department’s Excel file, with every row count and every figure cross-checked against the Department’s PDF of the same exhibit. Free to download as one CSV of all seven exhibits, 7,553 rows, no sign-up.
What the rule says about this schedule
Per hour or per visit?
Both, in two separate blocks. The first four rows are private nursing care billed per hour: a registered nurse at $70, a licensed practical nurse at $65, a home health aide at $24. The next five are home health visits billed per visit: a registered nurse at $125, a physical therapist at $135, a speech therapist at $145, an occupational therapist at $135 and a medical social worker at $195.
Reading a $70 row against a $125 row as though they priced the same thing is the trap. They are different codes, S9123 and T1030, for different billing units. A bill claiming a per-visit rate for what was delivered as hourly nursing is priced on the wrong half of the table.
What is the live-in attendant row?
HCPCS S5126 at $180, and it is the one row whose label overrides the block it sits in. It appears under the per-hour heading, but its own description names a 24 hour shift, so $180 is a shift rate rather than an hourly one. The State's file even leaves the closing bracket off that label.
We reproduce the label exactly as published rather than tidying it, because the wording is the thing a reader has to check against a bill. Where a row's own description names a unit, that unit governs, not the heading above it.
Is home care priced by region?
No. Exhibit 3 has a single fee column, and 11:3-29.3(a) defines the North and South regions for Exhibit 1, Exhibit 2 and Exhibit 4 only. One rate applies across New Jersey for every row on this schedule.
11:3-29.4(b) still decides which schedule applies where care is given outside the State, and 29.4(d) governs that case: emergency or medically necessary care elsewhere is priced at the usual and customary fee for that location, while elective care elsewhere is priced under the schedule for the region the insured lives in.