265.983 The Prudent Physician Paradigm:
It is MSSNY’s position that if a physician excises a clinically suspicious skin lesion, the insurer should be held liable for payment for the surgical procedure regardless of the subsequent pathology report.
MSSNY will request legislative or regulatory action that when a physician performs an indicated procedure based on a presumptive diagnosis, the third party payer reimburse the physician performing the procedure regardless of the final diagnosis. (HOD 1998-271; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
