Bill Text: NJ S982 | 2024-2025 | Regular Session | Introduced
Bill Title: 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.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2024-01-09 - Introduced in the Senate, Referred to Senate Commerce Committee [S982 Detail]
Download: New_Jersey-2024-S982-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator KRISTIN M. CORRADO
District 40 (Bergen, Essex and Passaic)
SYNOPSIS
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.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning evaluation and management billing codes, and supplementing P.L.1999, c.155 (C.17B:30-26 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health insurance carrier shall utilize the resource-based relative value scale used by the federal Centers for Medicare and Medicaid Services, pursuant to 42 U.S.C. s.1395w-4, when determining the reimbursement value for evaluation and management billing codes appended by modifier 25.
b. As used in this section:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, and shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
"Evaluation and management billing codes" means current procedural terminology codes 99202 through 99499 that represent services by a healthcare provider in which the provider is either evaluating or managing a patient's health.
"Modifier 25" means a code to delineate when a patient's condition requires a significant, separately identifiable evaluation and management service above and beyond that associated with another procedure or service being reported by the same healthcare provider on the same date as the evaluation and management service.
"Reimbursement value" means the monetary amount a healthcare provider receives for providing a medical service or performing a medical procedure.
"Resource-based relative value scale" means a payment system used by the federal Centers for Medicare and Medicaid Services that assigns monetary value to medical services and procedures based upon the resources needed by a healthcare provider to effectively deliver or perform the service or procedure.
2. This act shall take effect on the 90th day next following the date of enactment and shall apply to policies or contracts that are delivered, issued, executed, or renewed on or after the effective date.
STATEMENT
This bill requires health insurance carriers to use a federal resource-based relative value scale when determining reimbursement values for certain evaluation and management billing codes.
Under the bill, a carrier will be required to utilize the resource-based relative value scale used by the federal Centers for Medicare and Medicaid Services when determining the reimbursement value for evaluation and management billing codes appended by modifier 25. As defined under the bill, "resource-based relative value scale" means a payment system used by the federal Centers for Medicare and Medicaid Services that assigns monetary value to medical services and procedures based upon the resources needed by a healthcare provider to effectively deliver or perform the service or procedure. This bill is intended to set a standard for reimbursement values of evaluation and management services performed by healthcare providers.
