NJ PIP Fee Schedule Exhibit 1: Physicians' and ASC Facility Fees

How to read this table

Mod

Blank is the global service. TC is the technical component, 26 the professional component, under 11:3-29.4(l).

Physicians' North, South

The physician's own fee, chosen by the region where the service was rendered (11:3-29.3, 29.4(b)).

ASC North, South

The facility fee an ambulatory surgery center may be paid for the same code. It is separate money from the physician's fee, not an alternative to it.

not listed

In a physicians' column: no fee is published, and the service is still reimbursable. 11:3-29.4(e) prices it and FAQ Answer 5 says so outright. 1,828 rows are in this state.

not payable in ASC

In an ASC column: no facility fee is published, so the facility fee is not reimbursable when the service is done in an ASC (11:3-29.5(a), 29.4(e)3). It does not touch the physician's fee for the same code.

packaged

An ASC column with payment indicator N1. The service may be performed in an ASC, but its facility fee is paid inside another procedure instead of on its own line.

X

Payment indicator: this ASC code is not subject to the multiple procedure reduction.