NJMMIS Terms of Use and Licensing Agreement(s)

(All NJMMIS users must agree to these Terms to continue)

Combined Agreement for use of CPT and CDT codes

Current Procedural Terminology (“CPT”) codes, descriptions and other data only are copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). Applicable FARS/DFARS apply.

Current Dental Terminology (“CDT” or CDTTM”) codes, nomenclature, descriptions and other data contained here are Copyright ©2015 American Dental Association (ADA). All rights reserved. Applicable FARS/DFARS apply. All rights reserved. CDT is a trademark of the ADA.

You, your employees, the organization you have the authority to represent and it employees and agents are authorized to use the CPT and CDT only as contained in the following authorized materials of the Center for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, your employees, the organization you are authorized to represent and its employees and agents. Use is limited to use in Medicare, Medicaid and other programs administered by CMS. You agree to take all necessary steps to insure that you, your employees, organization and agents abide by the terms of this agreement. Any use not authorized herein is prohibited.

CPT and CDT are provided “as is” without warranty of any kind, either expressed or implied, including but not limited, the implied warranties of merchantability and fitness for a particular purpose.

The AMA, ADA and CMS disclaim responsibility for any consequences or liability attributable to or related to any use, non-use or interpretation of information contained or not contained in this product/file. This agreement will terminate upon notice if you violate the terms.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking the box “I agree”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. If acting on behalf of an organization you, you represent you have the authority to act on their behalf.

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Rate Information

Coronavirus Rates

Hospital Rates
  • Hospital Cost-to-charge ratio is used to reimburse a hospital for outpatient services on an interim basis. The hospital is then settled for outpatient services at the lower of cost or charges when their cost report is audited. The payment is calculated as the cost-to-charge ratio times billed charges.
  • Inpatient Hospital Rates and Cost to Charge Ratios are used in conjunction with DRG weights to determine payment for inpatient services. The inpatient cost to charge ratio serves as the basis for any cost outlier payment for Medicaid inpatient services being provided by the hospital.
  • .
  • Inpatient Per Diem Rates for Psychiatric, Rehabilitation and Special Hospitals.  - CY2022  CY2021   CY2020  CY2019  CY2018 
  • State-Wide Average Nursing Facility Rate is the per diem amount used to pay eligible lower level of care days which exceed the average length of stay for a particular DRG.
  • Supporting Documentation regarding the calculation of the most current hospital rate add-on amounts is also available for hospital reference.
    • Add-ons -       CY2022 
  • Out of State Hospital Pricing - Acute Facility
DRG Pricing
Hospice Rates Information
Federally Qualified Health Center information
Home Health Agency Rates
Nursing Home Rates (LTC)
Procedure Code Listings
  • Procedure Master Listing - Medicaid Fee for Service                                              
  • Procedure Master Listing - Anesthesia Services                                           - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Procedures Requiring PA                                   - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Children's Rates                                                 - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Outpatient Hospital Services Only                      - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Outpatient Hospital Laboratory Billing Only        - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - ACA Enhanced Rates                                         - CY2014
  • Procedure Master Listing - Non Covered APIs/Excipients                            - CY2016  CY2015
  • Procedure Master Listing - Outpatient Psychiatric Services Only                  - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Provider Payment Increase for Specific Codes   - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - New Codes                                                          - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Deleted Codes                                                     - CY2022  CY2021  CY2020  CY2019   
  • Procedure Master Listing - Ambulatory Surgical Center                                 - CY2022  CY2021  CY2020  CY2019   
ICD Diagnosis Code and Surgical Procedure Code Files
NJ FamilyCare Clinical Criteria Grid for Dental Services
MAPS Exhibits - Operational Manual     - FY 2023  FY 2022  FY 2021  FY 2020  FY 2018 
Independent Certified Disproportionate Share Hospital (DSH) Reports
  • NJ DSH Audit Reports                             - FY2017  FY2016  FY2015    

 Assisted Living Rates                                  - FY2023