S 982 New Jersey Senate · 2024-2025 Regular Session

Requires health insurance carriers to use federal resource-based relative value scale when determining reimbursement values for evaluation and management billing codes appended by modifier 25.

This bill requires all health insurers in New Jersey to use the federal Centers for Medicare & Medicaid Services' payment system (which sets rates based on provider costs) when reimbursing doctors for certain separate office visits. Specifically, it applies to "evaluation and management" medical codes (used for patient check-ups) when a separate, significant visit occurs on the same day as another procedure (denoted by "modifier 25"). The change ensures insurers base payments on a standardized federal method rather than their own calculations. This directly affects healthcare providers who bill for these specific types of visits and aims to create consistent reimbursement rates across the state.
Sub-Topics: Medicare
Bill status in committee 1 of 4 stages cleared
Introduction
Jan 2024
Committee Review
Floor Vote
Governor
Introduced Jan 9, 2024 Last action Jan 9, 2024
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Jan 9, 2024
Senate · Introduced
Introduced in the Senate, Referred to Senate Commerce Committee
1 primary · 0 co-sponsors

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Role
Legislator
Party
State
District
P
Photo of Kristin Corrado
Kristin Corrado
RRepublican
NJ
40