Bill Text: NY A10303 | 2021-2022 | General Assembly | Introduced

---

Bill Title: Requires the use of the current edition of American medical association's current procedural terminology (CPT) with respect to claims for evaluation and management codes.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2022-05-13 - referred to insurance [A10303 Detail]

Download: New_York-2021-A10303-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          10303

                   IN ASSEMBLY

                                      May 13, 2022
                                       ___________

        Introduced  by COMMITTEE ON RULES -- (at request of M. of A. Gunther) --
          read once and referred to the Committee on Insurance

        AN ACT to amend the insurance law and the public health law, in relation
          to the processing of health claims

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Paragraph  2  of  subsection (a) of section 3224-b of the
     2  insurance law, as added by chapter 551 of the laws of 2006,  is  amended
     3  to read as follows:
     4    (2) Subject to the provisions of paragraph three of this subsection, a
     5  health  plan shall accept and initiate the processing of all health care
     6  claims submitted by a physician, including but not limited to evaluation
     7  and management codes,  pursuant  to  and  consistent  with  the  current
     8  version  of the American medical association's current procedural termi-
     9  nology (CPT) codes, reporting guidelines and conventions and the centers
    10  for medicare and medicaid services healthcare  common  procedure  coding
    11  system (HCPCS).
    12    §  2.  Paragraphs  4  and 5 of subsection (b) of section 3224-b of the
    13  insurance law, as amended by chapter 237 of the laws of 2009, are renum-
    14  bered paragraphs 5 and 6 and a new paragraph  4  is  added  to  read  as
    15  follows:
    16    (4)  Notwithstanding  paragraph three of this subsection, with respect
    17  to claims for evaluation and management codes as such  are  defined  and
    18  set  forth  in  the  current  edition  of American medical association's
    19  current procedural terminology (CPT), a health plan shall follow, comply
    20  with and implement for purposes of claims processing, claims payment and
    21  claims review, such current procedural  terminology  provisions,  guide-
    22  lines  and  conventions  for both the selection and the documentation of
    23  evaluation and management services.
    24    § 3. Section 4406-c of the public health law is amended by adding  two
    25  new subdivisions 13 and 14 to read as follows:
    26    13.  A  health  maintenance  organization licensed pursuant to article
    27  forty-three of the insurance law or certified pursuant to  this  article
    28  or  an independent practice association certified or recognized pursuant

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15680-01-2
        A. 10303                            2

     1  to this article or a medical group shall not  prohibit  the  acceptance,
     2  initiation  and  processing  of  all  health  care claims submitted by a
     3  physician, including but not limited to evaluation and management codes,
     4  pursuant  to  and  consistent  with  the current version of the American
     5  medical association's current procedural  terminology  (CPT),  reporting
     6  guidelines  and  conventions  and  the centers for medicare and medicaid
     7  services healthcare common procedure coding system (HCPCS).
     8    14. Notwithstanding provisions of this section or paragraph  three  of
     9  subsection  (b) of section three thousand two hundred twenty-four of the
    10  insurance law, with respect to  claims  for  evaluation  and  management
    11  codes as such are defined and set forth in the current edition of Ameri-
    12  can medical association's current procedural terminology (CPT), a health
    13  plan  shall  follow,  comply  with  and implement for purposes of claims
    14  processing, claims payment and claims review,  such  current  procedural
    15  terminology   provisions,  guidelines,  and  conventions  for  both  the
    16  selection  of  and  the  documentation  of  evaluation  and   management
    17  services.
    18    §  4. The commissioner of health and the superintendent of the depart-
    19  ment of financial services shall promulgate rules  and  regulations  and
    20  take  any other actions reasonably necessary to implement the provisions
    21  of this act.
    22    § 5. This act shall take effect immediately.