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Expanded list of services eligible for separate reimbursement above capitation (NJ only)

Beginning January 1, 2012, an expanded list of services eligible for separate reimbursement above capitation for HMO/POS products will be implemented for New Jersey primary care physicians (PCP) who are reimbursed on a capitated basis. This new expanded list includes the following services:

99173: Vision screening test
99217 – 99220: Observation – Initial care
99221 – 99223: Initial hospital care
99224 – 99226: Subsequent observation care
99231 – 99233: Subsequent hospital care
99234 – 99236: Observation/Inpatient care services – Admission and discharge services
99238 – 99239: Hospital discharge services

To view a complete list of services that are currently eligible for separate payment above the monthly PCP capitation fee, please see Attachment B to Claim Payment Policy #00.10.01o: Services Paid Above Capitation for Health Maintenance Organization (HMO) Primary Care Physicians, which is available by entering the policy number in the Search box on our medical policy website at www.amerihealth.com/medpolicy.

If you have any questions regarding this update, please contact your Network Coordinator.