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Page 1

43 NJR 8(1)

August 1, 2011

Filed July 8, 2011

INSURANCE

DEPARTMENT OF BANKING AND INSURANCE

OFFICE OF PROPERTY AND CASUALTY

Personal Injury Protection

Personal Injury Protection Benefits: Medical Protocols; Diagnostic Tests

Personal Injury Protection Dispute Resolution

Medical Fee Schedules: Automobile Insurance Personal Injury Protection and Motor Bus

Medical Expense Insurance Coverage

Proposed New Rules: N.J.A.C. 11:3-4.7A, 4.7B, 29.5 and 11:3-29 Appendix, Exhibits 1

through 6

Proposed Amendments: N.J.A.C. 11:3-4.2, 4.4, 4.7, 4.8, 4.9, 5.2, 5.4, 5.5, 5.6, 5.12 and 29.1

through 29.4

Proposed Repeals: N.J.A.C. 11:3-29 Appendix, Exhibits 1 through 7

Authorized By: Thomas B. Considine, Commissioner, Department of Banking and Insurance.

Authority: N.J.S.A. 17:1-8.1, 17:1-15e, 17:29A-14c(4), 17:33B-42, 39:6A-1.2, 39:6A-3.1,

39:6A-4, 39:6A-4.3, 39:6A-5.1, 39:6A-5.2 and 39:6A-19.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2011-163.

Submit comments by September 30, 2011 to:

Page 2

2

Robert J. Melillo, Chief

Legislation and Regulation

New Jersey Department of Banking and Insurance

20 West State Street

PO Box 325

Trenton, NJ 08625-0325

Fax: (609) 292-0896

Email: [email protected]



The agency proposal follows:



Summary

Pursuant to N.J.S.A. 39:6A-1 et seq., owners or registrants of an automobile in New

Jersey are required to maintain automobile liability insurance in mandated amounts. N.J.S.A.

39:6A-4 provides that every standard automobile liability insurance policy issued or renewed on

or after the effective date of N.J.S.A. 39:6A-1.1 et seq. shall contain personal injury protection

(PIP) benefits for the payment of benefits without regard to negligence, liability or fault of any

kind, to the named insured and members of his or her family residing in his household who

sustain bodily injury as a result of an accident while occupying, entering into, alighting from or

using an automobile, or as a pedestrian, caused by an automobile or by an object propelled by or

from an automobile, and to other persons sustaining bodily injury while occupying, entering into,

alighting from or using the automobile of the named insured, with permission of the named

insured.

Page 109

109

74010 X-RAY ABDOMEN ANTEROPOST
& ADDED VW

63.95 60.30

74010 TC X-RAY ABDOMEN ANTEROPOST
& ADDED VW

46.53 43.43 87.24 80.31

74010 26 X-RAY ABDOMEN ANTEROPOST
& ADDED VW

17.44 16.85

74020 X-RAY ABDOMEN COMPLETE 67.15 63.37
74020 TC X-RAY ABDOMEN COMPLETE 46.53 43.43 87.24 80.31
74020 26 X-RAY ABDOMEN COMPLETE 20.62 19.94
74022 X-RAY EXAM SERIES, ABDOMEN 80.75 76.17
74022 TC X-RAY EXAM SERIES, ABDOMEN 56.42 52.67 112.32 103.38
74022 26 X-RAY EXAM SERIES, ABDOMEN 24.33 23.50
74150 CT ABDOMEN W/O DYE 415.67 390.94
74150 TC CT ABDOMEN W/O DYE 323.11 301.44 375.45 345.60
74150 26 CT ABDOMEN W/O DYE 92.56 89.50
74160 CT ABDOMEN W/DYE 621.20 583.19
74160 TC CT ABDOMEN W/DYE 512.35 477.98 580.71 534.51
74160 26 CT ABDOMEN W/DYE 108.84 105.22
74170 CT ABDOMEN W/O & W/DYE 748.27 701.76
74170 TC CT ABDOMEN W/O & W/DYE 639.30 596.40 647.37 595.86
74170 26 CT ABDOMEN W/O & W/DYE 108.98 105.36
74175 CT ANGIO ABDOM W/O & W/DYE 817.07 767.28
74175 TC CT ANGIO ABDOM W/O & W/DYE 668.42 623.56 655.71 603.54
74175 26 CT ANGIO ABDOM W/O & W/DYE 148.66 143.73
74176 CT ANGIO ABDOM & PELVIS 357.22 337.86
74176 TC CT ANGIO ABDOM & PELVIS 225.87 210.73 375.45 345.60
74176 26 CT ANGIO ABDOM & PELVIS 131.35 127.13
74177 CT ANGIO ABDOM & PELVIS

W/CONTRAST
568.57 535.21

74177 TC CT ANGIO ABDOM & PELVIS
W/CONTRAST

430.84 401.94 580.71 534.51

74177 26 CT ANGIO ABDOM & PELVIS
W/CONTRAST

137.73 133.28

74178 CT ANGIO ABDOM & PELVIS 1+
REGNS

721.91 678.79

74178 TC CT ANGIO ABDOM & PELVIS 1+
REGNS

569.43 531.21 647.37 595.86

74178 26 CT ANGIO ABDOM & PELVIS 1+
REGNS

152.50 147.58

74181 MRI ABDOMEN W/O DYE 780.43 731.90
74181 TC MRI ABDOMEN W/O DYE 667.25 622.46 664.20 611.37
74181 26 MRI ABDOMEN W/O DYE 113.19 109.42
74183 MRI ABDOMEN W/O & W/DYE 1,261.00 1,182.28
74183 TC MRI ABDOMEN W/O & W/DYE 1,086.50 1,013.56 1,033.50 951.27
74183 26 MRI ABDOMEN W/O & W/DYE 174.49 168.71
74220 CONTRAST X-RAY, ESOPHAGUS 151.79 142.85
74220 TC CONTRAST X-RAY, ESOPHAGUS 115.82 108.07 167.97 154.59
74220 26 CONTRAST X-RAY, ESOPHAGUS 35.97 34.77
74230 CINE/VIDEO X-RAY,

THROAT/ESOPH
153.59 144.71

74230 TC CINE/VIDEO X-RAY,
THROAT/ESOPH

112.32 104.80 167.97 154.59

74230 26 CINE/VIDEO X-RAY,
THROAT/ESOPH

41.27 39.89

74241 X-RAY EXAM, UPPER GI TRACT
W/KUB

198.98 187.44

74241 TC X-RAY EXAM, UPPER GI TRACT 146.09 136.31 167.97 154.59

Page 110

110

W/KUB
74241 26 X-RAY EXAM, UPPER GI TRACT

W/KUB
52.88 51.12

74246 CONTRAST X-RAY UGI TRACT
W/O KUB

213.47 200.98

74246 TC CONTRAST X-RAY UGI TRACT
W/O KUB

159.49 148.82 167.97 154.59

74246 26 CONTRAST X-RAY UGI TRACT
W/O KUB

53.99 52.18

74280 CONTRAST X-RAY COLON W/WO
GLUCOGEN

357.90 336.48

74280 TC CONTRAST X-RAY COLON W/WO
GLUCOGEN

281.19 262.33 274.98 253.11

74280 26 CONTRAST X-RAY COLON W/WO
GLUCOGEN

76.71 74.15

74290 CONTRAST X-RAY,
GALLBLADDER

115.11 108.23

74290 TC CONTRAST X-RAY,
GALLBLADDER

90.78 84.71 167.97 154.59

74290 26 CONTRAST X-RAY,
GALLBLADDER

24.33 23.50

74330 X-RAY BILE/PANCREAS
ENDOSCOPY

300.56 290.09 N1

74330 TC X-RAY BILE/PANCREAS
ENDOSCOPY

230.31 222.27 N1

74330 26 X-RAY BILE/PANCREAS
ENDOSCOPY

72.02 69.63 N1

74400 CONTRAST X-RAY URINARY
TRACT

188.82 177.48

74400 TC CONTRAST X-RAY URINARY
TRACT

150.75 140.66 301.83 277.83

74400 26 CONTRAST X-RAY URINARY
TRACT

38.07 36.82

74410 CONTRAST X-RAY URINARY
TRACT

194.65 182.91

74410 TC CONTRAST X-RAY URINARY
TRACT

155.99 145.55 312.36 287.52

74410 26 CONTRAST X-RAY URINARY
TRACT

38.65 37.36

74415 CONTRAST X-RAY URINARY
TRACT

230.76 216.59

74415 TC CONTRAST X-RAY URINARY
TRACT

192.68 179.77 341.13 313.98

74415 26 CONTRAST X-RAY URINARY
TRACT

38.07 36.82

74420 CONTRAST X-RAY URINARY
TRACT

219.86 212.18

74420 TC CONTRAST X-RAY URINARY
TRACT

190.87 184.20 341.13 313.98

74420 26 CONTRAST X-RAY URINARY
TRACT

28.56 27.63

74425 CONTRAST X-RAY URINARY
TRACT

124.29 119.97 N1

74425 TC CONTRAST X-RAY URINARY
TRACT

95.30 91.97 N1

74425 26 CONTRAST X-RAY URINARY
TRACT

28.56 27.63 N1

74430 CONTRAST X-RAY BLADDER 102.29 96.28 N1
74430 TC CONTRAST X-RAY BLADDER 77.96 72.76 N1
74430 26 CONTRAST X-RAY BLADDER 24.33 23.50 N1
74450 X-RAY URETHRA/BLADDER 132.84 128.21 N1
74450 TC X-RAY URETHRA/BLADDER 106.33 102.60 N1

Page 218

218

97035

ULTRASOUND, EACH 15 MINUTES DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97036

HUBBARD TANK, EACH 15 MINUTES DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97039 UNLISTED PHYSICAL MEDICINE & REHAB MODALITY

97110

THERAPEUTIC PROCEDURE, 1 OR MORE AREAS,
EACH 15 MINUTES; THERAPEUTIC EXERCISES TO
DEVELOP STRENGTH AND ENDURANCE, RANGE OF
MOTION AND FLEXIBILITY

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97112

NEUROMUSCULAR REEDUCATION OF MOVEMENT,
BALANCE COORDINATION, KINESTHETIC SENSE,
POSTURE, AND/OR PROPRIOCEPTION FOR SITTING
OR STANDING ACTIVITIES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97113 AQUATIC THERAPY WITH THERAPEUTIC EXERCISES

97124

MASSAGE THERAPY DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97139 UNLISTED PHYSICAL MEDICINE PROCEDURE

97140

MANUAL THERAPY TECHNIQUES (eg
MOBILIZATION/MANIPULATION, MANUAL LYMPHATIC
DRAINAGE, MANUAL TRACTION, 1 OR MORE
REGIONS, EACH 15 MINUTES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97150

GROUP THERAPEUTIC PROCEDURES, (2 OR MORE
INDIVIDUALS) CONSTANT

ATTENDANCE OF
PROVIDER
REQUIRED

97530

THERAPEUTIC ACTIVITIES, (USE OF DYNAMIC
ACTIVITIES TO IMPROVE FUNCTIONAL
PERFORMANCE)

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97535 SELF CARE MANAGEMENT TRAINING

97810

ACUPUNCTURE, 1 OR MORE NEEDLES, WITHOUT
ELECTRICAL STIMULATION, INITIAL 15 MINUTES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97811

ACUPUNCTURE, 1 OR MORE NEEDLES, WITHOUT
ELECTRICAL STIMULATION, EACH ADDITIONAL 15
MINUTES, WITH REINSERTION OF NEEDLES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97813

ACUPUNCTURE, 1 OR MORE NEEDLES, WITH
ELECTRICAL STIMULATION, INITIAL 15 MINUTES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

97814

ACUPUNCTURE, 1 OR MORE NEEDLES, WITH
ELECTRICAL STIMULATION, EACH ADDITIONAL 15
MINUTES, WITH REINSERTION OF NEEDLES

DIRECT ONE-ON-
ONE PATIENT
CONTACT
REQUIRED

98925 OSTEOPATHIC MANIPULATION 1-2 REGIONS
98926 OSTEOPATHIC MANIPULATION 3-4 REGIONS
98927 OSTEOPATHIC MANIPULATION 5-6 REGIONS
98928 OSTEOPATHIC MANIPULATION 7-8 REGIONS

Page 219

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98929 OSTEOPATHIC MANIPULATION 9-10 REGIONS
98940 CHIROPRACTIC MANIPULATION 1-2 REGIONS
98941 CHIROPRACTIC MANIPULATION 3-4 REGIONS
98942 CHIROPRACTIC MANIPULATION 5 REGIONS

98943

CHIROPRACTIC MANIPULATION EXTRASPINAL, 1 OR
MORE REGIONS









NOTE: FOR CHIROPRACTIC MANIPULATIVE TREATMENT, THE 5 SPINAL REGIONS REFERRED TO ARE:
CERVICAL REGION (INCLUDES ATLANTO-OCCIPITAL JOINT); THORACIC REGION (INCLUDES
COSTOVERTEBRAL AND COSTOTRANSVERSE JOINTS); LUMBAR REGION; SACRAL REGION; AND PELVIC
(SACRO-ILIAC JOINT) REGION. THE FIVE EXTRA-SPINAL REGIONS REFERRED TO ARE: HEAD (INCLUDING
TEMPOROMANDIBULAR JOINT, EXCLUDING ATLANTO-OCCIPITAL) (EXCLUDING COSTOTRANSVERSE AND
COSTOVERTEBRAL JOINTS AND ABDOMEN)


NOTE: FOR OSTEOMANIPULATIVE TREATMENT, THE BODY REGIONS REFERRED TO ARE: HEAD REGION;

CERVICAL REGION; THORACIC REGION; LUMBAR REGION; SACRAL REGION; PELVIC REGION; LOWER
EXTREMITIES; UPPER EXTREMITIES; RIB CAGE REGION; ABDOMEN AND VISCERA REGION






NOTE: FOR STRAPPING, THIS IS A REPLACEMENT PROCEDURE USED DURING OR AFTER THE PERIOD OF
FOLLOW-UP CARE OR WHEN THE APPLICATION IS AN INITIAL SERVICE PERFORMED WITHOUT A
RESTORATIVE TREATMENT TO STABILIZE OR PROTECT A FRACTURE, INJURY OR DISLOCATION AND/OR
TO AFFORD COMFORT TO A PATIENT.

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