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NJ Attending Provider Treatment Plan (APTP) Form

Every provider treating a New Jersey PIP patient uses this uniform form to submit decision point review and precertification requests to the auto insurer under the Medical Protocols rule (N.J.A.C. 11:3-4). It replaced the forms individual insurers used before and sets out proposed treatment, diagnostic tests or durable medical equipment with codes, frequency, duration and supporting diagnoses for the insurer's review.

Who completes it

The attending provider, such as the treating physician, chiropractor or physical therapist, completes and signs the whole form, setting out diagnoses and clinically supported findings. DME vendors and other non-treating providers are not meant to submit it.

Submitting and payment

How to submit it
Send it with supporting records to the patient's PIP insurer or its decision point review vendor by fax, email or upload as the insurer's Decision Point Review Plan directs; the insurer must decide within 3 business days.
Who pays
The PIP insurer pays for approved treatment under New Jersey's automobile medical fee schedule; the APTP is the precertification step, not the bill.

Good to know

  • Box 36 holds diagnoses A to L with an ICD-9 or ICD-10 indicator; the box 38 diagnosis pointer links each service line to up to four of them, primary first.
  • With a CPT code range, total units apply across the range, not to each code. List codes separately to request a set number of units for each one.
  • Each item checked in box 35 history, such as prior MRI, surgery or comorbidities, needs a brief description and date on a separate attachment. Send SOAP notes and test results too.
  • If the insurer denies or modifies the request, the provider files the uniform PIP Pre-Service Appeal Form before going to arbitration.

Get the official form

Download the current version from the source each time; forms change without notice.

Attending Provider Treatment Plan

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Do all New Jersey auto insurers have to accept the APTP?

Yes. DOBI's Order A16-101 made it the uniform form for decision point review and precertification requests, and no insurer may refuse the generic form. DOBI prefers that insurers not add substantive changes. Red print is not required, so providers may print it in black.

Is the APTP required for every PIP claim?

No. It is used when treatment, testing or equipment needs decision point review or precertification under N.J.A.C. 11:3-4 and the insurer's Decision Point Review Plan. DOBI posts the current Version 2.1 (3/2016) as a PDF and an Excel file, and care paths CP1 to CP6 are checked in item 37 when they apply.

Who signs the APTP and what are they certifying?

The attending provider signs item 39, stating they personally completed and previewed the form and that it is true and correct to the best of their knowledge, beneath New Jersey's fraud prevention warning. DME vendors and other non-treating providers supply items once the attending provider finds them medically necessary.