NJ S3264

Requires New Jersey health insurance carriers to use the federal Medicare resource-based relative value scale (RBRVS) when determining reimbursement amounts for evaluation and management billing codes (CPT codes 99202-99499) appended with modifier 25

Modifier 25 applies when a patient's condition requires a significant, separately identifiable evaluation and management service beyond another procedure performed by the same provider on the same date

Applies to all insurance companies, health service corporations, HMOs, and includes the State Health Benefits Program and School Employees' Health Benefits Program

Takes effect 90 days after enactment and applies to policies delivered, issued, executed, or renewed after the effective date

Sponsored by Senator Kristin M. Corrado (District 40 - Bergen, Essex and Passaic) and introduced February 2, 2026