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Updated New York Workers' Compensation Medical Fee Schedule Effective 4/1/19

by NYSCA Workers Compensation Committee | 4/1/2019 9:30:55 AM

Don't forget to implement the New NYS Workers' Compensation Fee Schedule for services rendered on and after 4/1/19.  

According to the Workers' Compensation Board, 'The Official New York Workers' Compensation Medical Fee Schedule may be purchased from OptumInsight 360 by writing to PO Box 88050, Chicago, IL 60680-9920, by calling (800) 464-3649 option 1 or online at www.optum360coding.com, keyword New York, or www.optum360coding.com/Product/40508/.

The Fee Schedule may also be examined at the Office of the Department of State (162 Washington Ave, Albany NY 12231), the Legislative Library, the libraries of the New York State Supreme Court, and the Workers' Compensation Board District Offices.'

Since the reimbursement rates are different for services rendered after 4/1/19 (most have increased significantly), you may find it desirable to bill for services rendered prior to this date on a separate claim form to facility your internal processing of claims.

Although the Workers' Compensation Fee Schedule also applies to No Fault cases in New York, the Department of Financial Services has announced that only Ground Rule 10 will be adopted at this time.  Ground Rule 10 limits the services you may bill to those listed in the fee schedule.  

The DFS has announced that there is a delay in implementing the new fee schedule for No Fault cases until 10/01/2020 due to the mandatory one year policy period requirement that no fault carriers must abide by.  Ground Rule 3 (which addresses the maximum amount of RVUs that can be billed per day) has not yet been adopted. 

As previously announced, the NYSCA has objected to any limitation in the provision of medically necessary services which is within our scope of practice.  Furthermore, the Workers' Compensation Board has advised the NYSCA that service not listed on the new fee schedule that are approved via the Variance Process would be eligible for reimbursement. 

The NYSCA continues to advocate for the profession and is actively working on these issues, please check back for updates as they occur.


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