The 2018 New York Workers’ Compensation Fee Schedule (The New Fee schedule) governs the 2023 No-Fault billing and reimbursement regulations in New York. 

As of April 1, 2019 the  New Fee Schedule directives were implemented and therefore applicable to NY No-Fault billing. However, the increased reimbursement rates were not implemented until October 1, 2020. Thus, bills for dates of service October 1, 2020 and later are subject to the new fee schedule’s increased reimbursement rates and should be billed accordingly. Alternatively, bills pre-dating October 1, 2020 are still subject to the old fee schedule reimbursement rates.  

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The proposed amendments also include Nurse Practitioners, Physician Assistants, and Licensed Clinical Social Workers to the existing fee schedule.

It is important to bill the correct fee schedule amount as overbilling will lead to a denial of  No-Fault benefits. Additionally, overbilling could lead to the insurance carrier conducting an Examination Under Oath (EUO) of the medical provider who is billing incorrectly. An EUO can delay payment of bills for a considerable amount of time and can end in the permanent denial of claims. 

Below are some noteworthy changes that will affect No-Fault providers:

  1. Maximum reimbursement per day for all providers that are billing for physical modalities has been increased from 8.0 to 12.0 Relative Value Units (RVUs). This number is capped at 12.0 RVUs regardless of what the provider’s specialty is . For example, if a chiropractor bills 6.0 RVUs of physical modality for the same day that a physical therapist has billed 6.0 RVUs that would exhaust  the 12 RVU cap for that day. 
  1. Range of motion (ROM) testing and Physical Performance testing has been given a RVU of 0 and thus will not be reimbursed. It is instead considered to be inclusive of a comprehensive exam. 
  1. Radiology Ground Rule  number 3(F) states “that imaging studies taken within 7 days of the first imaging study and related to the injury or problem that necessitated the first imaging study, and which could have been reasonably performed at one time, shall be subject to a reduction.”  

The New York No-Fault Collections attorneys at the TonaLaw firm have over 50 combined years of experience representing healthcare providers in the collection of No-Fault receivables. The attorneys at TonaLaw have helped clients recover moneys paid for Medicare, Medicaid, Worker’s Compensation, health insurance liens, and lost wages claims for Personal Injury clients whose No-Fault benefits were improperly denied. Further, the attorneys at TonaLaw recover thousands every year in lost wages for their clients. Mr. Tona wrote the “No Stress No-Fault” healthcare provider’s guide to New York State No-Fault insurance which has become an invaluable resource used by hundreds of practitioners across  New York. 

If you’d like to learn more,  send your mailing address to [email protected] to be placed on the waitlist to receive the updated edition of the guide after it is published. To order a copy of the WCB Fee Schedule for your applicable practice areas please click here.

The full text of the changes has been transcribed in its entirety and provided below.

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You can also reach out in the chat below, by email at [email protected], or give us a call at 1-833-TONALAW 

Workers’ Compensation Board

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

Medical Fee Schedules

I.D. No. WCB-27-19-00005-P

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action: Addition of Part 329-4; amendment of Part 333, sec­tions 301.3, 329-1.3 and 348.2 of Title 12 NYCRR.

Statutory Authority: Workers’ Compensation Law, sections 13, 117 and 141

Subject: Medical Fee Schedules.

Purpose: Add new providers to the fee schedule.

Text of Proposed Rule: Section 329-1.3 of Title 12 NYCRR is hereby amended to read as follows:

  1. The medical fee schedule for medical services shall be the Official New York Workers’ Compensation Medical Fee Schedule, updated July 3, 2019, prepared by the board and published by Optumlnsight, which is herein incorporated by reference.
  2. The Official New York Workers’ Compensation Medical Fee Schedule incorporated by reference herein may be examined at the office of the Department of State, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the board. Copies may be purchased from Optumlnsight, by writing to Official New York Workers’ Compensation Fee Schedule, PO Box 88050, Chicago, 1L 60680-9920; by telephone at 1-800-464-3649, option 1; or online at www.optum360coding.com keyword New York or click here.

A new part 329-4 is hereby added to read as follows:

Part 329-4 Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule

    cl

 

  • 329-4.1 Application
  1. The fee schedule applicable to acupuncture services shall be the acupuncture fee schedule in effect on the date on which the acupuncture services were rendered, regardless of the date of accident.
  2. The fee schedule applicable to physical therapy and occupational therapy services shall be the physical therapy and occupational therapy fee schedule in effect on the date on which the physical therapy or occupational therapy services were rendered, regardless of the date of accident.
  • 329-4.2 Acupuncture and physical therapy and occupational therapy fee schedule; incorporation by reference
  1. The acupuncture fee schedule for acupuncture services shall be the Official New York Workers· Compensation Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule, created July 3, 2019 prepared by the Board and published by Optumlnsight, which is herein incorporated by reference.
  2. The physical therapy and occupational therapy fee schedule for physical therapy and occupational therapy services shall be the Official New York Workers’ Compensation Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule, created July 3, 2019, prepared by the Board and published by Optumlnsight, which is herein incorporated by reference.
  3. The Official New York Workers’ Compensation Acupuncture and Physical Therapy Fee Schedule incorporated by reference herein may be examined OJ the office of the Department of State, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the Board. Copies may be purchased from Optumlnsight, by writing to Official New York Workers’ Compensation Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; by telephone at 1-800- 464-3649, option 1; or online at www.optum360coding.com keyword New York or https://www.optum360coding.com/Product/40508/.

Part 333 of Title 12 NYCRR is hereby amended to read as follows:

  • 333.1 Application

The fee schedule applicable to psychological services shall be the behavioral health fee schedule in effect on the date on which the psychological services were rendered, regardless of the date of accident.

  • 333.2 Behavioral Health fee schedule; incorporation by reference
  1. The behavioral health fee schedule for psychology services shall be the official New York Workers· Compensation Behavioral Health Fee Schedule, updated July 3, 2019, prepared by the Board and published by Optumlnsight, which is herein incorporated by reference.
  2. The Official New York Workers’ Compensation Behavioral Health Fee Schedule incorporated by reference herein may be examined at the office of the Department of State, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the board. Copies may be purchased from Optumlnsight. by writing to Official New York Workers’ Compensation Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; by telephone at 1-800-464-3641, option 1; or online at www.optum360coding.com keyword New York or https://www.optum360coding.com/Product/40508/.

Section 348.2 of Title 12 NYCRR is hereby amended to read as follows:

  1. The chiropractic fee schedule for chiropractic services shall be the Official New York Workers’ Compensation Chiropractic Fee Schedule, updated July 3, 2019, prepared by the Board and published by Optumlnsight, which is herein incorporated by reference.
  2. The Official New York Workers· Compensation Chiropractic Fee Schedule incorporated by reference herein may be examined at the office of the Department of State. One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the board. Copies may be purchased from Optumlnsight, by writing to Official New York Workers’ Compensation Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; by telephone at l-800-464-3649, option l; or online at www.optum360coding.com keyword New York or https://www.optum360coding.com/Product/40508/.

Section 301.3 of Title 12 NYCRR is hereby amended to read as follows:

  • 301.3 Section 301.3. Fees for attendance of chiropractors, nurse practitioner, licensed clinical social workers, and psychologists at hearings

Whenever the attendance of the injured employee’s treating or consultant chiropractor, nurse practitioner, licensed clinical social worker, or psychologist at a hearing is required, such chiropractor, nurse practitioner, licensed clinical social worker, or psychologist shall be entitled to an attendance fee of $350. In instances involving special circumstances, the board may fix a fee in an amount greater than the said sum, such increased fee to be commensurate with the circumstances in the particular case. Where the attendance is pursuant to a subpoena issued by the board, the Workers’ Compensation Law judge or any officer of the board so designated by the chair, the attendance fee may be limited to no more than $70.

Text of proposed rule and any required statements and analyses may be obtained from:

Heather MacMaster, Workers’ Compensation Board, 328 State Street, Office of General Counsel, Schenectady, NY 12305, (518) 486-9564, email: [email protected]

Data, views or arguments may be submitted to: Same as above.

Public comment will be received until: 60 days after publication of this notice .

This rule was not under consideration at the time this agency submitted its Regulatory Agenda for publication in the Register.

Regulatory Impact Statement

 

  1. Statutory Authority

The statutory authority for this rule comes from §§ 13, 117(1) and 141 of the Workers’ Compensation Law, which allows the Chair to adopt reasonable rules to supplement the provisions of the chapter and the labor law.

  1. Legislative Objectives

In April 2019, the amendments to section 13-b of the workers’ compensation law were enacted. The new law expanded the categories of providers who may become authorized to treat injured workers to include nurse practitioners, physician assistants, licensed clinical social workers, physical and occupational therapists and acupuncturists.

The proposed amendments add nurse practitioners, physician assistants and licensed clinical social workers to the existing fee schedules and adds a new fee schedule for acupuncturists and physical and occupational therapists. The proposal also provides for testimony fees for nurse practitioners and licensed clinical social workers.

  1. Needs and Benefits

The bill expanding the list of providers who can become authorized to treat injured workers under the Workers’ Compensation Law will provide more access to different types of providers, and more types of medical care for injured workers. Modifications to the chiropractic fee schedule will align them with fee for similar types of new providers.

The chair is required to set fee schedules for medical providers treating injured workers. Fee schedules also create clarity and reduce billing disputes.

  1. Costs

The proposed amendments should not impose significant costs. Modifications to the chiropractic fee schedule will align them with fee for similar types of new providers. New providers may wish to purchase the medical fee schedules and interested parties may wish to purchase the Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule. By amending the current fee schedule and combining acupuncture and physical and occupational therapy into a single fee schedule, the Board seeks to minimize any costs.

  1. Local Government Mandates

There are no specific mandates on local governments as a result of this proposal.

  1. Paperwork

The proposal does not require any additional paperwork.

  1. Duplication

There is no duplication of state or federal regulations or standards.

  1. Alternatives

The Board did not consider any other alternative as the fee schedules are required by statute and this model follows the existing fee schedule framework. Modifications to the chiropractic fee schedule will align them with fee for similar types of new providers. By amending the current fee schedule and combining acupuncture and physical and occupational therapy into a single fee schedule, the Board seeks to minimize any costs.

  1. Federal Standards

There are no applicable federal standards or regulations related to the proposed amendments.

  1. Compliance Schedule

The statute becomes takes effect January 1, 2022.

Regulatory Flexibility Analysis

 

  1. Effect of rule

The statute expands the list of providers that may become authorized to treat injured workers under the NYS Workers’ Compensation Law. This may mean that new provider types added in the statute that operate as small businesses will now be able to apply for authorization.

  1. Compliance requirements

The proposal updates existing fee schedules to include new providers and adds fee schedules for acupuncturists and physical and occupational therapists.

  1. Professional services

It is believed that no professional services will be needed by small businesses or local governments to comply with the proposed regulation.

  1. Compliance costs

Compliance with the proposed regulations should not impose compliance costs on small businesses or local governments unless such small business are new providers and wish to purchase the fee schedules. In such a case, the fee schedules would facilitate an increase in income due to participation in the workers’ compensation system.

  1. Economic and technological feasibility

Compliance with the proposed regulations is technologically and economically feasible for small business and local government. No technology is required.

  1. Minimizing adverse impact

The proposed fee schedules are drafted in accordance with the Board’s current fee schedule. The new providers are being added to the existing fee schedule and acupuncture and physical and occupational therapy are being paired in a single fee schedule to minimize cost.

  1. Small business and local government participation

The Board will duly consider all public comments received from small businesses or local governments during the public comment period.

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Thank you Jeff for everything you have done for us!!If you are looking for an attorney, that goes above beyond, look no further, Jeff Donato will make sure all your needs are taken care of.James McCartneyJames McCartney ★★★★★ I have know attorney Jeff Donato for many years and he is an asset. I would absolutely use Tonalaw for my personal injury needs!Joe MazzilloJoe Mazzillo ★★★★★ We have known Jeff Donato for over 20 years. Anytime we have had any questions pertaining to a law issue he has been always nothing but professional and knowledgeable. We would go to TonaLaw for any personal injury matters or legal advice. Definitely recommended!!Andrea O'NeillAndrea O'Neill ★★★★★ Jeff Donato is an honest, hardworking person who I have known for 25+ years. He has always been and will be in the future my go to person. When my Dad was getting older I needed hep on what to do with his house and money so it did not go to the state, he helped me to find the right direction. He has always been professional and I never think twice about recommending Jeff to anyone who may need an attorney to hire or for honest advice. He has even helped me get in touch with people in other professions outside of an attorney .Steve NassoSteve Nasso ★★★★★ I’ve known Jeffrey Donato at TonaLaw for over 30 years and he represents a fantastic firm. I personally love how much work they do and support they provide their community. Every year they do a Veterans Scholarship and they were recently spotted at The Making Strides Against Breast Cancer Walk which is especially close to my heart. Kudos and keep up the good work!!Linda HlentzasLinda Hlentzas ★★★★★ Very happy to see attorney Jeffrey Donato at this firm. I worked with Mr. Donato for many years in another law office. He is very approachable,responsible and is extremely knowledgeable in all phases of personal injury. Top of my list if you need a personal injury lawyer! You will be satisfied!michaelmichael ★★★★★ Tona Law has been a blessing to me. The staff cares about you, I mean actually genuinely cares about you. In my experience working with Jayda, Jeff, Lauren, and Robyn (so much energy! Love it) I have been handled with love and empathy. They treated me like family and won me over. When I got home from surgery there was a box of cookies waiting for me, that is a team who cares. They call to see how you’re doing, they are more than attorneys, they’re good people I consider family at this point. God bless the Tona Law staff. Would highly recommend to everyone, God’s honest truth.Amy Beth (Amy Beth)Amy Beth (Amy Beth) ★★★★★ Tom Tona and his team are fantastic. They do a great job for their clients. Can't recommend them highly enough. Lauren McCormick was very helpful and knowledgeable with all of my questions and concerns.Athena DuranAthena Duran ★★★★★ Lauren McCormick is hardworking and such a sweet person dedicated to her career. Anyone is definitely in good hands with her!Walter CoppolaWalter Coppola ★★★★★ Marcus DiWorldMarcus DiWorld ★★★★★ Jayda is extremely thorough and friendly! A wonderful addition to a great teamJasper AlindoganJasper Alindogan ★★★★★ As far as paralegals go, Lauren McCormick knows her job inside and out and anyone working with her would benefit immensely from that. She is also one of the kindest and sweetest people I have ever met. TonaLaw is lucky to have such a great person as part of their family!Pamela SucatoPamela Sucato ★★★★★ Lauren is an amazing addition to this firm . I have worked with her over the years and she is always professional and efficient and pleasant to deal with . Good luck looking forward to working with you in the future .Pamela claims resolution servicesIan HysellIan Hysell ★★★★★ Lauren is one of the hardest working people I know.Melissa HysellMelissa Hysell ★★★★★ Lauren is a hardworking, loyal and dedicated individual.Mercedes IregbulemMercedes Iregbulem ★★★★★ Jayda goes above and beyond to make sure she helps everyone she speaks with. She is truly a gem! I would recommend TonaLaw’s services to anyone in need!Gregory AudigeGregory Audige ★★★★★ Jayda Brown is amazing to work with! She’s sweet, well informed, and overall just a huge help. If you’re looking for a hardworking and dedicated team, you won’t regret hiring TonaLawKathleen MontanizKathleen Montaniz ★★★★★ I know Andrew Ciccaroni personally, and in my time getting yo know him, I've always found him to be very knowledgeable on the law.Amber PalermoAmber Palermo ★★★★★ The professionalism and expertise of the TonaLaw team is unmatched. I’ve worked with Juliet and she was incredibly knowledgeable, friendly and I could tell that she cared about helping me. If you’re looking for a legal team that helps with you any problem, big or small, TonaLaw is a team you can trust.Rolanda SmithRolanda Smith ★★★★★ Choosing Tona Law is the best decision you could make! Everyone is so helpful and informative every step of the way. Jada is sweet, knowledgable, and always available to answer any questions and will make sure you feel like you're in good hands! I would recommend Tona Law to anyone looking for help with their personal injury mattersJames CunninghamJames Cunningham ★★★★★ They were so nice and gave me great advice!!Alison CiccaroniAlison Ciccaroni ★★★★★ I'm not a client but if I was looking for a law firm that is both trustworthy and knowledgeable in the law, I'd choose TonaLaw as I've discussed legal issues with one of their attorneys and he has shown extensive knowledge.Teresa MercurioTeresa Mercurio ★★★★★ I’ve known Andrew Ciccaroni personally for years. He trustworthy and attentive. Does the best job he possibly can with all the resources he has access to.js_loader