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.
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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Full legislative history
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1
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Jan 9, 2024
Senate · Introduced
Introduced in the Senate, Referred to Senate Commerce Committee
1 primary · 0 co-sponsors
Sponsors
Role
Legislator
Party
State
District
P
Kristin Corrado
RRepublican
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