The Correct NJ PIP Allowance for Every Code, in One Paste
The NJFS & UCR Lookup Tool tells you what New Jersey PIP rules allow for any medical procedure code. Paste a list of CPT or HCPCS codes and get the state fee-schedule cap and the Usual, Customary and Reasonable benchmark for each one, resolved by region, provider type, and modifier, in a single grid.
From a pasted code to a full pricing grid
The tool loads its reference data once, normalizes each code, resolves any crosswalk, then returns every region and provider-type value in a single grid.
Fee tables load at startup
NJFS, hospital schedule, UCR, crosswalk rules
Held in memory from access-controlled storage
A reviewer pastes codes
One or more CPT/HCPCS codes, one per line
Optional modifiers such as -50, -RT, -TC, -26
Codes reduce to a base code
Keeps pricing-relevant -TC and -26 modifiers
Discards modifiers that do not change the fee
Three-pass crosswalk resolution
Mandatory remap, direct lookup, then fallback
Split targets used only when every piece is priced
Region and provider resolve at once
Doctor, Facility, Hospital in North and South NJ
Plus three UCR benchmarks, looked up directly
Results render as a grid
One row per code, CW flag on crosswalked values
Per-column copy into an audit worksheet
What does the NJFS & UCR Lookup Tool do?
The tool answers one question for every line on a medical bill: what is the correct reimbursable amount for this procedure under New Jersey PIP rules? You paste procedure codes, and it resolves the New Jersey Fee Schedule allowance and the UCR benchmark for each one, handling region, provider type, and modifiers automatically.
That single allowed number decides whether a bill line was overpaid, correctly paid, or underpaid. Under New Jersey no-fault insurance (Personal Injury Protection, or PIP), an injured driver’s own auto insurer pays their injury medical bills regardless of fault. Insurers do not pay whatever a provider bills. State regulation caps most reimbursements. The tool encodes those caps and the fallback benchmarks, so a reviewer sees the defensible number instead of hunting for it across large spreadsheets.
Why is the correct amount so hard to find by hand?
The correct reimbursement is not one number. It is a four-way lookup that depends on the procedure code, its modifier, the region of New Jersey, and the type of provider. The same code carries different allowances in the north and south of the state, and different allowances by provider type.
New Jersey’s PIP fee schedule is set by regulation under N.J.A.C. 11:3-29. It prices covered procedures, and for those procedures reimbursement is generally the lesser of the provider’s charge or the scheduled amount. When a procedure is not listed on the schedule, the rules fall back to a Usual, Customary and Reasonable benchmark, also called Fair and Reasonable. That benchmark reflects a market rate for the service. Reference data spans thousands of codes across many region and provider-type columns, plus modifier handling and crosswalk rules. Doing that lookup by hand for every line on every bill is slow and easy to get wrong.
What do the codes and modifiers mean?
A CPT or HCPCS code is a standardized five-character code for one medical procedure or service, such as an MRI, an office visit, or a spinal injection. A modifier is a two-character suffix that changes a code’s meaning or price. The tool reads both before it prices anything.
Two modifiers matter most for pricing. The -TC modifier marks the technical component, meaning the equipment and facility portion of a procedure. The -26 modifier marks the professional component, meaning the physician’s reading or interpretation. A single procedure can legitimately split into these two separately-priced pieces. The tool preserves -TC and -26 because they change the fee, and it strips modifiers that do not affect the lookup. This keeps the returned number aligned with how the procedure was actually billed.
What does a crosswalk do, and why does it matter?
A crosswalk is a rule that maps a billed code to a different code, or to the sum of two codes, so the correct allowance can be found when the billed code is not directly priced on the schedule. Crosswalks are common because not every billable code carries its own listed price.
The tool’s crosswalk engine is conservative by design. When a target splits across two codes, the tool uses it only if every component has a listed fee. If any piece is missing, it returns no value rather than a partial one. This prevents a subtle failure mode where a partial sum would look like a real allowance and quietly understate the correct amount. Every value reached through a crosswalk is flagged “CW” in the grid, so a reviewer always knows which numbers came from a direct listing and which came from a mapping. Nothing is hidden behind the final figure.
Who is the tool for?
The NJFS & UCR Lookup Tool is built for the people who decide what a PIP medical bill should have paid: New Jersey no-fault claim reviewers, medical-bill auditors, defense attorneys and paralegals, and expert-report analysts who need the correct reimbursable amount for procedure codes.
These users work at the line-item level. A single bill can carry dozens of codes, each needing its own region-aware, provider-type-aware allowance. The tool matches that workflow: it accepts a whole list of codes at once and returns a full results row for each, with per-column copy so numbers move cleanly into an audit worksheet or an expert report. For teams that also need automated pricing across large document sets, the lookup pairs with our automated PIP bill-review engine and the broader S2Reason product suite.
Not a spreadsheet, and not a generic lookup
The tool resolves all four pricing dimensions in one paste and returns the full six-cell NJFS grid plus three UCR benchmarks per code. It stays in sync with the engines that price bills, so manual and automated numbers draw on the same source.
Four-way resolution in one step
One paste returns the full NJFS grid plus UCR benchmarks per code, across code, modifier, region, and provider type.
New Jersey PIP rules encoded
North and South region splits, Doctor versus Facility versus Hospital pricing, and modifier-aware technical and professional components.
Built-in crosswalk engine
Handles codes that must be remapped to another code, or to the sum of two codes, and flags every crosswalked value.
No misleading partial fees
If a crosswalk target is missing any component fee, the tool returns no value instead of a partial, misleading one.
Aligned with automated pricing
The same fee tables and crosswalk logic feed the automated bill-review pipeline, so manual and automated numbers stay in sync.
Batch-first workflow
Accepts a whole list of codes and offers per-column copy, matching how New Jersey claim reviewers actually work.
Is the NJFS & UCR Lookup Tool secure?
Yes. The tool is deployed as a hardened web service on single-tenant, compliance-first infrastructure. It runs as a non-root container with a strict Content-Security-Policy, HSTS, and nosniff headers, and it exposes resolved allowance numbers only, never the underlying reference files.
S2Reason builds systems engineered to meet HIPAA standards, running on AWS and Google Cloud infrastructure that holds independent SOC 2 Type II attestation and is GDPR-compliant, with single-tenant isolation, a signed Business Associate Agreement chain, encryption in transit and at rest, and audit trails. Reference fee data is pulled from private, access-controlled storage. Because the same fee tables and crosswalk logic are shared with the production bill-review pipeline, the human lookup and the automated engine stay in sync. You can read more about single-tenant isolation and the signed Business Associate Agreement chain on the S2Reason security page, or explore the rest of the S2Reason product suite.
NJFS and UCR lookup, answered
What is the NJ Fee Schedule (NJFS)?
The New Jersey Fee Schedule (NJFS) is the state-mandated price list for medical procedures under no-fault (PIP) auto insurance, set by regulation at N.J.A.C. 11:3-29. For covered procedures it caps what an insurer must reimburse, generally at the lesser of the provider's charge or the scheduled amount.
What is UCR, and when does it apply?
UCR (Usual, Customary and Reasonable) is the benchmark market rate that applies when a procedure code is not listed on the New Jersey fee schedule. Also called Fair and Reasonable, it gives a reviewer a defensible number to reimburse against when the state schedule is silent.
Why does the same CPT code have different allowed amounts in New Jersey?
New Jersey prices the same code differently by region, provider type, and modifier, so one code can carry six fee-schedule values plus three UCR benchmarks. North and South New Jersey price separately. Doctor's offices, surgery facilities, and hospitals each get their own column. Modifiers -TC and -26 split a procedure into separately priced technical and professional parts. The tool resolves all of these at once.
What is a crosswalk?
A crosswalk is a rule that maps a billed code to a different code, or to the sum of two codes, when the billed code is not directly priced. The tool flags every crosswalked value with a CW tag, and it never uses a split target unless every component has a listed fee.
Does the lookup match what the automated engines use?
Yes. The lookup tool and the automated bill-review pipeline draw on the same fee tables and crosswalk logic, so a number a reviewer looks up matches what the automated pricing produces.
Can I look up multiple CPT codes at once?
Yes. Paste a list of codes, one per line, and the tool returns a results row for each, with one-click copy for any column of values.