On October 3, 2018, The New York State Workers’ Compensation Board released a Revised Proposed 2018 Medical Fee Schedule. Changes proposed in this revised Fee Schedule will have a significant impact on the billing and treatment of No-Fault patients unless immediate action is taken.
Some of the most concerning proposed changes are as follows:
- For All Providers That Administer Physical Modalities: The Maximum reimbursement per day has been increased from 8.0 RVUs to 12.0 RVUs, but there is a limit of 12 RVUs per patient per day, regardless of the number of providers.
- For Physical Therapists: Ground Rule #2 of the Physical Medicine Section limits physical medicine services to 12 sessions/visits, and they must be rendered no more than 180 days from the first session/visit.
- For Chiropractors:
- As currently proposed, under Chiropractic Physical Medicine Ground Rule #3, physical medicine procedures and/or modalities must be performed within 180 days of the accident or illness date.
- Ground Rule #10 of the Chiropractic General Ground Rules limits a chiropractor to billing only the CPT codes contained in the Chiropractic Fee Schedule. A chiropractor may not use codes that do not appear in the Chiropractic Fee Schedule.
- CPT Code 97750 for Range of Motion (ROM) testing has been given a RVU of 0 and will not be reimbursable. Manual Muscle testing codes 95831-95852 are not contained in the Chiropractic Fee Schedule and are therefore not reimbursable.
- Codes for EMG/NCV testing are billable and found in the Chiropractic Fee Schedule, but the reimbursement value has been reduced.
- Radiologists and MRI Facilities: Radiology Ground Rule #3(F) states that imaging studies taken with 7 days of the first imaging study and related to the injury or problem necessitating the first imaging study, and which could have been reasonable performed at one time, shall be subject to reduction.
It is imperative that all No-Fault providers and their patients make their concerns known to the Board. The Board is required by law to consider comments at least until November 1st, 2018.
to view the full regulations.
Submit written comments to WCB via email:
For more information and updates on the development and implementation of the Fee Schedule proposal, please sign up below:
You can also reach out in the chat below or give us a call at 1-844TONALAW