DOBI Proposes Weekly Cap on New Jersey PIP Rehab Fees

DOBI Proposes Weekly Cap on New Jersey PIP Rehab Fees - Litigation Alert - October 2026 - Brach Eichler
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10/1/2026

On October 1, 2026, the New Jersey Department of Banking and Insurance (DOBI) issued an advance notice of rulemaking describing limited amendments to the Personal Injury Protection (PIP) Medical Fee Schedules. The core change would replace the current daily maximum allowable fee for Physical Medicine and Rehabilitation CPT codes with a weekly maximum. If adopted, the change would affect how PIP carriers reimburse, and how providers bill for, rehabilitative care after auto accidents in New Jersey.

What You Need to Know

  • The daily cap would become a weekly cap. DOBI would amend N.J.A.C. 11:3-29.4(m) to remove the $105.00 daily maximum allowable fee and replace it with a $1,015.00 weekly
  • The underlying rate would go up. The weekly figure reflects a daily maximum to $145.00 applied over seven days. That is roughly a 38% increase over the current daily rate.
  • “Weekly” would be defined. A new definition in N.J.A.C. 11:3-29.2 would set the week as seven calendar days, running Sunday through Saturday.
  • Treatment would be more flexible. According to DOBI, the change would let injured claimants get same-day treatment from different providers for injuries from the same accident. It would also allow additional procedures to be performed.
  • NCCI edits still apply. National Correct Coding Initiative (NCCI) edits would continue to govern billing.

Next Steps and Implications

DOBI is asking for input before it formally proposes the rule. Comments should be emailed to AdvanceNotice@dobi.nj.gov by October 15, 2026.

We Can Help

Please reach out with any questions.

Keith J. Roberts, Esq., Member and Chair, Litigation Practice, kroberts@bracheichler.com, 973.364.5202

Shannon Carroll, Esq., Member, Litigation Practice, scarroll@bracheichler.com, 973.403.3114

*This is intended to provide general information, not legal advice. Please contact the authors if you need specific advice.

Related Practices:   Litigation

Related Attorney:   Keith J. Roberts, Shannon Carroll