PCP Billable Lists
Billable services for fee-for-service PCPs
PCPs, in solo or group practices, who receive fee-for-service reimbursement for services provided to Horizon BCBSNJ managed care members, may bill for and receive fee-for-service reimbursement for all current procedural codes appropriate for their specialty. All reimbursements for services provided to Horizon BCBSNJ members are subject to the limits imposed by the physician's contract and the member's benefits.
Billable services for capitated PCPs.
Primary care physician (PCPs) in solo or group practices who receive capitation reimbursement may also submit claims/transactions (and be considered for fee-for-service reimbursement) for the codes below when provided to patients who are enrolled in certain Horizon BCBSNJ managed care plans AND who have pre-selected the rendering practitioner as his/her PCP.
This content was last revised on March 5, 2023 and may be subject to change.
10061
10080
10081
10140
11100
11101
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11600
11601
11602
11603
11620
11621
11622
11623
11640
11641
11642
11643
11730
11740
11750
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
15851
16020
17000
17003
17004
17110
17111
17250
17260
17261
17262
17263
17270
17271
17272
17273
17280
17281
17282
17283
20550
20600
20605
20610
20612
21920
21930
22010
22015
24065
24075
24200
24640
25065
25075
26750
27040
27323
27327
27613
27618
28043
28045
28190
28490
28510
29125
29126
29130
29131
29240
29260
29280
29530
29540
29550
29580
30901
30903
31500
31502
36010
36140
38300
38500
38505
45330
45331
45346
45378
45380
46050
46320
46924
51701
51702
54050
54060
54150
54160
54162
54450
55100
56405
56420
56440
56501
56605
57160
57170
58300
58301
62270
69000
69209
69210
69424
73140
73660
77080
77081
82247
82248
82270
82948
84703
86580
87220
87804
87880
90281
90283
90284
90287
90296
90371
90375
90376
90378
90384
90385
90389
90396
90460
90461
90471
90472
90473
90474
90586
90619
90620
90621
90625
90626
90627
90611
90622
90630
90632
90633
90634
90636
90644
90647
90648
90649
90650
90651
90653
90654
90655
90656
90657
90658
90660
90661
90662
90664
90666
90667
90668
90670
90672
90673
90674
90675
90676
90677
90680
90681
90682
90685
90686
90687
90688
90689
90690
90691
90694
90696
90698
90700
90702
90707
90710
90713
90714
90715
90716
90717
90723
90732
90733
90734
90736
90738
90739
90740
90743
90744
90746
90747
90748
90750
90756
90759
92950
92960
93015
93016
93017
93018
94010
94060
94640
94664
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
95180
96110
96372
97597
97598
97810
97811
97813
97814
99050
99291
99304
99305
99306
99307
99308
99309
99310
99341
99342
99344
99345
99347
99348
99349
99350
99360
99460
99461
99462
99463
99465
99468
99469
99471
99472
99477
99478
99479
99480
G0008
G0009
G0010
G0104
G0106
G0328
J0570
J0696
J0881
J0882
J0885
J1756
J1885
J2001
J3250
J3301
J3420
Q4081
S0610
S0612
S0613
V72.31