NJ Department of Banking and Insurance Proposes Amendments to PIP Regulations


NJ DOBI has proposed amendments to the PIP regulations to include fee schedule adjustments, CPT code updates, and increasing the threshold for on the papers (OTP) arbitrations.

N.J.S.A. 39:6A-4.6(a) provides statutory requirement for biennial inflation adjustment to the NJ PIP fee schedules.  DOBI now proposes to act in accordance with the statute, and adjust the applicable fee schedules based on U.S. Bureau of Labor Statistics Consumer Price Index.

Additionally, DOBI also proposes to update the PIP fee schedules to reflect 2016 current procedural terminology, as published by the American Medical Association (AMA CPT).  Importantly, the fee schedules will also be updated, to reflect amendments made by the Center for Medicare and Medicaid Services (CMS) and include procedures eligible for reimbursement to be performed in ambulatory surgery centers.

Finally, DOBI has proposed to amend N.J.A.C. 11:3-5.2, thereby raising the monetary threshold from $1,000 to $2,000 for OTP arbitration proceedings.  According to the Department, this change will affect approximately half the arbitrations currently filed making the arbitration system “work more efficient[ly] for claimants and payers, and thus continue to exert downward pressure on the automobile insurance premiums for PIP.”

Brach Eichler will be submitting formal comments to DOBI concerning all proposed regulatory changes. Therefore, we welcome your input while drafting our position for submission to the Department.

Related Practices:   Healthcare Law

Related Attorney:   Keith J. Roberts