Bill
Bill > S3264
NJ S3264
NJ S3264Requires 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.
summary
Introduced
02/02/2026
02/02/2026
In Committee
02/02/2026
02/02/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 Regular Session
Bill Summary
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.
AI Summary
This bill mandates that health insurance carriers in New Jersey must use the federal Resource-Based Relative Value Scale (RBRVS) when calculating how much to pay healthcare providers for specific evaluation and management (E/M) services, particularly those identified with modifier 25. The RBRVS is a payment system developed by the federal Centers for Medicare and Medicaid Services (CMS) that assigns a monetary value to medical services based on the resources—like time, skill, and effort—required to provide them. Modifier 25 is a special code used by doctors to indicate when a patient's condition requires a significant, separate E/M service in addition to another procedure performed on the same day. E/M billing codes, specifically those from 99202 to 99499, represent the services a healthcare provider performs to assess or manage a patient's health. By requiring the use of the federal RBRVS, this bill aims to standardize and potentially increase the reimbursement values for these common patient care services, ensuring providers are compensated fairly for the resources they expend.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 02/02/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2026/S3264 |
| BillText | https://pub.njleg.gov/Bills/2026/S3500/3264_I1.HTM |
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