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S3264 • 2026

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.

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.

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor
Corrado, Kristin M.
Last action
2026-02-02
Official status
Introduced in the Senate, Referred to Senate Commerce Committee
Effective date
Not listed

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

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.

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.

What This Bill Does

  • 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.
  • Topic: Commerce Fiscal note: This bill has not been certified by OLS for a fiscal note.

Limits and Unknowns

  • This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Bill History

  1. 2026-02-02 New Jersey Legislature

    Introduced in the Senate, Referred to Senate Commerce Committee

Official Summary Text

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.
Topic:
Commerce
Fiscal note:
This bill has not been certified by OLS for a fiscal note.

Current Bill Text

Read the full stored bill text 
S3264

SENATE, No. 3264

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED FEBRUARY 2, 2026

Sponsored by:

Senator� KRISTIN M. CORRADO

District 40 (Bergen, Essex and Passaic)

Co-Sponsored by:

Senator Lagana

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

���� As introduced.

��

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.