Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 00.01.55o


Attachment:A1

Policy #:00.01.55o

Description:NJ HMO & HMO-POS RADIOLOGY NETWORK RULES

Title:New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



NJ HMO & HMO-POS RADIOLOGY NETWORK RULES


NOTES:
  • The Effective Date indicates the effective date of the policy, the date the code became effective and/or the date the code was added to the NJ HMO & HMO-POS radiology network rule.
  • The Delete Date indicates either the date the code becomes invalid and/or the date the code is no longer included in the NJ HMO & HMO-POS radiology network rule.


RADIOLOGY NETWORK RULE AND LIMITED CIRCUMSTANCES

NETWORK RULES PROCEDURE CODE LIST

Procedure Code
Date Code Added to the Policy
Date Code Removed from the Policy
0042T
01-01-2003
0144T
01-01-2006
12-31-2009
0145T
01-01-2006
12-31-2009
0146T
01-01-2006
12-31-2009
0147T
01-01-2006
12-31-2009
0148T
01-01-2006
12-31-2009
0149T
01-01-2006
12-31-2009
0150T
01-01-2006
12-31-2009
0151T
01-01-2006
12-31-2009
0153T
01-01-2006
12-31-2007
0197T
01-01-2009
12-31-2014
0286T
01-01-2012
12-31-2016
0287T
01-01-2012
12-31-2016
0330T
07-01-2013
0331T
07-01-2013
0332T
07-01-2013
0346T
01-01-2014
01-01-2019
0348T
07-01-2014
0349T
07-01-2014
0350T
07-01-2014
0394T
01-01-2016
0395T
01-01-2016
0482T
01-01-2018
01-01-2020
0541T
01-01-2019
0542T
01-01-2019
54240
01-01-1984
70030
01-01-1984
70100
01-01-1984
70110
01-01-1984
70120
01-01-1984
70130
01-01-1984
70134
01-01-1984
70140
01-01-1984
70150
01-01-1984
70160
01-01-1984
70190
01-01-1984
70200
01-01-1984
70210
01-01-1984
70220
01-01-1984
70240
01-01-1984
70250
01-01-1984
70260
01-01-1984
70300
01-01-1984
70310
01-01-1984
70320
01-01-1984
70328
01-01-1984
70330
01-01-1984
70336
01-01-1989
70350
01-01-1984
70355
01-01-1984
70360
01-01-1984
70370
01-01-1984
70371
01-01-1988
70380
01-01-1984
70450
01-01-1984
70460
01-01-1984
70470
01-01-1984
70480
01-01-1984
70481
01-01-1984
70482
01-01-1984
70486
01-01-1984
70487
01-01-1984
70488
01-01-1984
70490
01-01-1984
70491
01-01-1984
70492
01-01-1984
70496
01-01-2001
70498
01-01-2001
70540
01-01-1986
70542
01-01-2001
70543
01-01-2001
70544
01-01-2001
70545
01-01-2001
70546
01-01-2001
70547
01-01-2001
70548
01-01-2001
70549
01-01-2001
70551
01-01-1986
70552
01-01-1990
70553
01-01-1992
70557
01-01-2004
70558
01-01-2004
70559
01-01-2004
71010
01-01-1984
12-31-2017
71015
01-01-1985
12-31-2017
71020
01-01-1985
12-31-2017
71021
01-01-1984
12-31-2017
71022
01-01-1984
12-31-2017
71023
01-01-1985
12-31-2017
71030
01-01-1984
12-31-2017
71034
01-01-1984
12-31-2017
71035
01-01-1982
12-31-2017
71045
01-01-2018
71046
01-01-2018
71047
01-01-2018
71048
01-01-2018
71100
01-01-1984
71101
01-01-1984
71110
01-01-1984
71111
01-01-1984
71120
01-01-1984
71130
01-01-1984
71250
01-01-1984
71260
01-01-1984
71270
01-01-1984
71275
01-01-2001
71550
01-01-1985
71551
01-01-2001
71552
01-01-2001
71555
01-01-1994
72010
01-01-1986
12/31/2015
72020
01-01-1984
72040
01-01-1984
72050
01-01-1984
72052
01-01-1984
72069
01-01-1991
12/31/2015
72070
01-01-1984
72072
01-01-1984
72074
01-01-1984
72080
01-01-1984
72081
01-01-2016
72082
01-01-2016
72083
01-01-2016
72084
01-01-2016
72090
01-01-1984
12/31/2015
72100
01-01-1984
72110
01-01-1984
72114
01-01-1984
72120
01-01-1984
72125
01-01-1984
72126
01-01-1984
72127
01-01-1986
72128
01-01-1984
72129
01-01-1984
72130
01-01-1986
72131
01-01-1984
72132
01-01-1984
72133
01-01-1986
72141
01-01-1987
72142
01-01-1990
72146
01-01-1990
72147
01-01-1990
72148
01-01-1990
72149
01-01-1990
72156
01-01-1992
72157
01-01-1992
72158
01-01-1992
72159
01-01-1994
72170
01-01-1984
72190
01-01-1984
72191
01-01-2001
72192
01-01-1984
72193
01-01-1984
72194
01-01-1984
72195
01-01-2001
72196
01-01-1988
72197
01-01-2001
72198
01-01-1994
72200
01-01-1984
72202
01-01-1984
72220
01-01-1985
73000
01-01-1984
73010
01-01-1984
73020
01-01-1984
73030
01-01-1984
73050
01-01-1984
73060
01-01-1984
73070
01-01-1984
73080
01-01-1984
73090
01-01-1984
73092
01-01-1984
73100
01-01-1984
73110
01-01-1984
73120
01-01-1984
73130
01-01-1984
73140
01-01-1984
73200
01-01-1984
73201
01-01-1984
73202
01-01-1984
73206
01-01-2001
73218
01-01-2001
73219
01-01-2001
73220
01-01-1986
73221
01-01-1989
73222
01-01-2001
73223
01-01-2001
73225
01-01-1994
73500
01-01-1984
12/31/2015
73501
01-01-2016
73502
01-01-2016
73503
01-01-2016
73510
01-01-1984
12/31/2015
73520
01-01-1984
12/31/2015
73521
01-01-2016
73522
01-01-2016
73523
01-01-2016
73530
01-01-1984
12/31/2015
73540
01-01-1984
12/31/2015
73550
01-01-1984
12/31/2015
73551
01-01-2016
73552
01-01-2016
73560
01-01-1984
73562
01-01-1984
73564
01-01-1983
73565
01-01-1991
73590
01-01-1984
73592
01-01-1984
73600
01-01-1984
73610
01-01-1984
73620
01-01-1984
73630
01-01-1984
73650
01-01-1984
73660
01-01-1984
73700
01-01-1984
73701
01-01-1984
73702
01-01-1984
73706
01-01-2001
73718
01-01-2001

Procedure Code
Date Code Added to the Policy
Date Code Removed from the Policy
73719
01-01-2001
73720
01-01-1986
73721
01-01-1989
73722
01-01-2001
73723
01-01-2001
73725
01-01-1994
74000
01-01-1984
12-31-2017
74010
01-01-1984
12-31-2017
74018
01-01-2018
74019
01-01-2018
74020
01-01-1984
12-31-2017
74021
01-01-2018
74022
01-01-1984
74150
01-01-1984
74160
01-01-1984
74170
01-01-1984
74174
01-01-2012
74175
01-01-2001
74176
01-01-2011
74177
01-01-2011
74178
01-01-2011
74181
01-01-1986
74182
01-01-2001
74183
01-01-2001
74185
01-01-1994
74210
01-01-1984
74220
01-01-1984
74221
01-01-2020
74230
01-01-1984
74240
01-01-1984
74241
01-01-1984
01-01-2020
74245
01-01-1984
01-01-2020
74246
01-01-1984
74247
01-01-1984
01-01-2020
74248
01-01-2020
74249
01-01-1984
01-01-2020
74250
01-01-1984
74251
01-01-1994
74260
01-01-1984
01-01-2020
74261
01-01-2010
12-31-2014
74262
01-01-2010
74263
01-01-2010
74270
01-01-1984
74280
01-01-1984
74283
01-01-1990
74290
01-01-1984
74291
01-01-1984
74400
01-01-1986
74410
01-01-1984
74415
01-01-1984
74420
01-01-1984
74710
01-01-1984
74712
01-01-2016
74713
01-01-2016
74775
01-01-1985
75552
01-01-1985
12-31-2007
75553
01-01-1994
12-31-2007
75554
01-01-1994
12-31-2007
75555
01-01-1994
12-31-2007
75556
01-01-1994
12-31-2007
75557
01-01-2008
75558
01-01-2008
12-31-2009
75559
01-01-2008
75560
01-01-2008
12-31-2009
75561
01-01-2008
75562
01-01-2008
12-31-2009
75563
01-01-2008
75564
01-01-2008
12-31-2009
75565
01-01-2010
75571
01-01-2010
75572
01-01-2010
75573
01-01-2010
75574
01-01-2010
75635
01-01-2001
75898
01-01-1984
76000
01-01-1984
76010
01-01-1985
76098
01-01-1987
76100
01-01-1984
76101
01-01-1984
76102
01-01-1984
76120
01-01-1984
76125
01-01-1984
76140
01-01-1984
76150
01-01-1984
01-01-2011
76350
01-01-1982
01-01-2011
76376
01-01-2006
76377
01-01-2006
76380
01-01-1992
76390
01-01-1998
76391
01-01-2019
76496
01-01-2003
76497
01-01-2003
76498
01-01-2003
76499
01-01-1984
76506
01-01-1982
76510
01-01-2005
76511
01-01-1982
76512
01-01-1982
76513
01-01-1988
76514
01-01-2004
76516
01-01-1982
76519
01-01-1986
76529
01-01-1982
76536
01-01-1986
76604
01-01-1982
12-31-2014
76641
01-01-2015
76642
01-01-2015
76645
01-01-1982
76700
01-01-1982
76705
01-01-1982
76706
01-01-2017
76770
01-01-1982
76775
01-01-1982
76800
01-01-1990
76801
01-01-2003
76802
01-01-2003
76805
01-01-1982
76810
01-01-1992

Procedure Code
Date Code Added to the Policy
Date Code Removed from the Policy
76811
01-01-2003
76812
01-01-2003
76813
01-01-2007
76814
01-01-2007
76815
01-01-1982
76816
01-01-1986
76817
01-01-2003
76818
01-01-1986
76819
01-01-2001
76820
01-01-2005
76821
01-01-2005
76825
01-01-1986
76826
01-01-1993
76827
01-01-1993
76828
01-01-1993
76830
01-01-1990
76831
01-01-1998
76856
01-01-1982
76857
01-01-1986
76870
01-01-1983
76872
01-01-1990
76873
01-01-2000
76880
01-01-1982
01-01-2011
76881
01-01-2011
76882
01-01-2011
76885
01-01-1998
76886
01-01-1998
76970
01-01-1986
76978
01-01-2019
76979
01-01-2019
76981
01-01-2019
76982
01-01-2019
76983
01-01-2019
76999
01-01-1984
77046
01-01-2019
77047
01-01-2019
77048
01-01-2019
77049
01-01-2019
77051
01-01-2007
12-31-2016
77052
01-01-2007
12-31-2016
77055
01-01-2007
12-31-2016
77056
01-01-2007
12-31-2016
77057
01-01-2007
12-31-2016
77058
01-01-2007
01-01-2019
77059
01-01-2007
01-01-2019
77061
01-01-2015
77062
01-01-2015
77063
01-01-2015
77065
01-01-2017
77066
01-01-2017
77067
01-01-2017
77071
01-01-2007
77072
01-01-2007
77073
01-01-2007
77074
01-01-2007
77075
01-01-2007
77076
01-01-2007
77077
01-01-2007
77078
01-01-2007
77079
01-01-2007
12-31-2011
77080
01-01-2007
77081
01-01-2007
77082
01-01-2007
12-31-2014
77083
01-01-2007
12-31-2011
77084
01-01-2007
77085
01-01-2015
77086
01-01-2015
77261
01-01-1984
77262
01-01-1984
77263
01-01-1984
77280
01-01-1984
77285
01-01-1984
77290
01-01-1984
77293
01-01-2014
77295
01-01-1994
77299
01-01-1984
77300
01-01-1984
77301
01-01-2002
77305
01-01-1984
12-31-2014
77306
01-01-2015
77307
01-01-2015
77310
01-01-1984
12-31-2014
77315
01-01-1984
12-31-2014
77316
01-01-2015
77317
01-01-2015
77318
01-01-2015
77321
01-01-1984
77326
01-01-1984
12-31-2014
77327
01-01-1984
12-31-2014
77328
01-01-1984
12-31-2014
77331
01-01-1984
77332
01-01-1984
77333
01-01-1984
77334
01-01-1984
77336
01-01-1984
77338
01-01-2010
77370
01-01-1984
77385
01-01-2015
77386
01-01-2015
77387
01-01-2015
77399
01-01-1984
77401
01-01-1991
77402
01-01-1991
77403
01-01-1991
12-31-2014
77404
01-01-1991
12-31-2014
77406
01-01-1991
12-31-2014
77407
01-01-1991
77408
01-01-1991
12-31-2014
77409
01-01-1991
12-31-2014
77411
01-01-1991
12-31-2014
77412
01-01-1991
77413
01-01-1991
12-31-2014
77414
01-01-1991
12-31-2014
77416
01-01-1991
12-31-2014
77417
01-01-1991
77418
01-01-2002
12-31-2014
77422
01-01-2006
12-31-2017
77423
01-01-2006
77424
01-01-2012
77425
01-01-2012
77427
01-01-2000
77431
01-01-1991
77432
01-01-1994
77469
01-01-2012
77470
01-01-1984
77499
01-01-1984
77600
01-01-1986
77605
01-01-1986
77610
01-01-1986
77615
01-01-1986
77620
01-01-1988
77750
01-01-1984
77761
01-01-1984
77762
01-01-1984
77763
01-01-1984
77767
01-01-2016
77768
01-01-2016
77770
01-01-2016
77771
01-01-2016
77772
01-01-2016
77776
01-01-1983
12/31/2015
77777
01-01-1984
12/31/2015
77778
01-01-1984
77781
01-01-1991
12-31-2008
77782
01-01-1991
12-31-2008
77783
01-01-1991
12-31-2008
77784
01-01-1991
12-31-2008
77785
01-01-2009
12/31/2015
77786
01-01-2009
12/31/2015
77787
01-01-2009
77789
01-01-1984
77790
01-01-1984
77799
01-01-1984

Procedure Code
Date Code Added to the Policy
Date Code Removed from the Policy
78000
01-01-1984
01-01-2013
78001
01-01-1984
01-01-2013
78003
01-01-1984
01-01-2013
78006
01-01-1984
01-01-2013
78007
01-01-1984
01-01-2013
78010
01-01-1984
01-01-2013
78011
01-01-1984
01-01-2013
78012
01-01-2013
78013
01-01-2013
78014
01-01-2013
78015
01-01-1984
78016
01-01-1984
78018
01-01-1984
78020
01-01-1999
78070
01-01-1989
78071
01-01-2013
78072
01-01-2013
78075
01-01-1984
78099
01-01-1984
78102
01-01-1984
78103
01-01-1984
78104
01-01-1984
78110
01-01-1984
78111
01-01-1984
78120
01-01-1984
78121
01-01-1984
78122
01-01-1987
78130
01-01-1984
78135
01-01-1984
78140
01-01-1984
78185
01-01-1984
78190
01-01-1991
12-31-2017
78191
01-01-1984
78195
01-01-1984
78199
01-01-1984
78201
01-01-1984
78202
01-01-1984
78205
01-01-1988
01-01-2020
78206
01-01-1999
01-01-2020
78215
01-01-1984
78216
01-01-1984
78220
01-01-1984
12-31-2011
78223
01-01-1984
12-31-2011
78226
01-01-2012
78227
01-01-2012
78230
01-01-1984
78231
01-01-1984
78232
01-01-1984
78258
01-01-1987
78261
01-01-1984
78262
01-01-1984
78264
01-01-1984
78265
01-01-2016
78266
01-01-2016
78267
01-01-2000
78268
01-01-2000
78270
01-01-1985
01-01-2019
78271
01-01-1985
01-01-2019
78272
01-01-1984
01-01-2019
78278
01-01-1984
78282
01-01-1985
78290
01-01-1984
78291
01-01-1985
78299
01-01-1984
78300
01-01-1984
78305
01-01-1984
78306
01-01-1984
78315
01-01-1987
78320
01-01-1988
01-01-2020
78350
01-01-1986
78351
01-01-1986
78399
01-01-1984
78414
01-01-1984
78428
01-01-1984
78429
01-01-2020
78430
01-01-2020
78431
01-01-2020
78432
01-01-2020
78433
01-01-2020
78434
01-01-2020
78445
01-01-1984
78451
01-01-2010
78452
01-01-2010
78453
01-01-2010
78454
01-01-2010
78456
01-01-2000
78457
01-01-1984
78458
01-01-1984
78459
01-01-1996
78460
01-01-1988
12-31-2009
78461
01-01-1988
12-31-2009
78464
01-01-1988
12-31-2009
78465
01-01-1988
12-31-2009
78466
01-01-1988
78468
01-01-1988
78469
01-01-1988
78472
01-01-1988
78473
01-01-1992
78478
01-01-1992
12-31-2009
78480
01-01-1992
12-31-2009
78481
01-01-1988
78483
01-01-1992
78491
01-01-1998
78492
01-01-1998
78494
01-01-1999
78496
01-01-1999
78499
01-01-1984
78579
01-01-2012
78580
01-01-1984
78582
01-01-2012
78584
01-01-1984
12-31-2011
78585
01-01-1984
12-31-2011
78586
01-01-1984
12-31-2011
78587
01-01-1984
12-31-2011
78588
01-01-1999
12-31-2011
78591
01-01-1984
12-31-2011
78593
01-01-1984
12-31-2011
78594
01-01-1984
12-31-2011
78596
01-01-1991
12-31-2011
78597
01-01-2012
78598
01-01-2012
78599
01-01-1984
78600
01-01-1984
78601
01-01-1984
78605
01-01-1984
78606
01-01-1984
78607
01-01-1988
01-01-2020
78608
01-01-1994
78609
01-01-1994
78610
01-01-1984
78615
01-01-1984
12-31-2007
78630
01-01-1984
78635
01-01-1984
78645
01-01-1984
78647
01-01-1995
01-01-2020
78650
01-01-1984
78660
01-01-1984
78699
01-01-1984
78700
01-01-1984
78701
01-01-1984
78707
01-01-1984
78708
01-01-1998
78709
01-01-1998
78710
01-01-1988
01-01-2020
78725
01-01-1984
78730
01-01-1984
78740
01-01-1984
78761
01-01-1984
78799
01-01-1984
78800
01-01-1984
78801
01-01-1984
78802
01-01-1984
78803
01-01-1988
78804
01-01-2004
78805
01-01-1984
01-01-2020
78806
01-01-1984
01-01-2020
78807
01-01-1994
01-01-2020
78808
01-01-2009
78811
01-01-2005
78812
01-01-2005
78813
01-01-2005
78814
01-01-2005
78815
01-01-2005
78816
01-01-2005
78890
01-01-1984
12-31-2008
78999
01-01-1984
79005
01-01-2005
79101
01-01-2005
79200
01-01-1984
79300
01-01-1984
79403
01-01-2004
79440
01-01-1984
79445
01-01-2005
79999
01-01-1982

Procedure Code
Date Code Added to the Policy
Date Code Removed from the Policy
91200
01-01-2015
93303
01-01-1997
93304
01-01-1997
93306
01-01-2009
93307
01-01-1982
93308
01-01-1982
93312
01-01-1989
93314
01-01-1993
93315
01-01-1997
93317
01-01-1997
93318
01-01-2001
93320
01-01-1982
93321
01-01-1990
93325
01-01-1990
93350
01-01-1990
93351
01-01-2009
93355
01-01-2015
93875
01-01-1992
12-31-2011
93880
01-01-1992
93882
01-01-1992
93886
01-01-1992
93888
01-01-1992
93890
01-01-2005
93892
01-01-2005
93893
01-01-2005
93895
01-01-2015
93922
01-01-1994
93923
01-01-1994
93924
01-01-1994
93925
01-01-1992
93926
01-01-1992
93930
01-01-1992
93931
01-01-1992
93965
01-01-1992
12-31-2016
93970
01-01-1992
93971
01-01-1992
93975
01-01-1992
93976
01-01-1992
93978
01-01-1992
93979
01-01-1992
93980
01-01-1993
93981
01-01-1993
93985
01-01-2020
93986
01-01-2020
93990
01-01-1995
A9700
01-01-2001
12-31-2008
G0130
01-01-1999
G0202
01-01-2002
12-31-2017
G0204
01-01-2002
12-31-2017
G0206
01-01-2002
12-31-2017
G0219
01-01-2002
G0237
01-01-2002
G0252
10-01-2002
G0279
01-01-2015
G0288
01-01-2003
G0365
01-01-2005
01-01-2020
G0458
01-01-2013
G6003
01-01-2015
G6004
01-01-2015
G6005
01-01-2015
G6006
01-01-2015
G6007
01-01-2015
G6008
01-01-2015
G6009
01-01-2015
G6010
01-01-2015
G6011
01-01-2015
G6012
01-01-2015
G6013
01-01-2015
G6014
01-01-2015
G6015
01-01-2015
G6016
01-01-2015
G6017
01-01-2015
Q0092
01-01-1993
Q3001
01-01-2001
Q9958
07-01-2005
Q9959
07-01-2005
Q9960
07-01-2005
Q9961
07-01-2005
Q9962
07-01-2005
Q9963
07-01-2005
Q9964
07-01-2005
R0070
01-01-1982
R0075
01-01-1986
S8032
10-01-2014
09-30-2016
S8037
01-01-2002
S8042
04-01-2002
S8055
01-01-2002
S8080
01-01-2001
S8085
01-01-2001


Version Effective Date: 01/01/2020
Version Issued Date: 05/19/2020
Version Reissued Date: N/A



2017 AmeriHealth.