N.Y. Comp. Codes R. & Regs. tit. 11, Appendices, app 17-C

Current through Register Vol. 46, No. 45, November 2, 2024

Appendix 17-C

(cf. § 68.3)

Introduction.

Regional conversion factors are used in the Workers' Compensation medical fee schedule to recognize differences in the cost of conducting a medical practice in various geographic regions of the State. Regional conversion factors were developed after a study was made by the chair of the Workers' Compensation Board.

The components considered in the study made by the chair of the Workers' Compensation Board relative to the cost of conducting a medical practice generally apply to dentists, social workers, speech therapists and optometrists and, while there may be differences in some components, it has been determined by the superintendent that the percentage difference in relative cost by region applicable to physicians is also applicable to the cost of conducting a dental, social worker, speech therapy, optometric practice and by a thermographic technician. This determination will maintain consistency between the schedules established by the chair of the Workers' Compensation Board and specified schedules established by the superintendent under section 5108 of the New York Insurance Law.

Regional conversion factors are listed in Parts A, C, D, I and L of this Appendix. For this purpose there are established four regions, based on the differences in the cost of maintaining various health provider practices in different localities of the State. The regions defined in Appendix 17-A of this Title, using United States Postal Service ZIP codes for the State of New York, are hereby adopted as being applicable to Parts A, C, D, I and L of this Appendix.

The fee payable for care and treatment rendered by health care providers in accordance with Parts A, C, D, I and L of this Appendix shall be determined by the region in which the services were rendered.

There are hereby established for each region the following regional conversion factors for the indicated Parts of this Appendix:

REGIONAL CONVERSION FACTORS

*Region I*	*Region II*	*Region III*	*Region IV*
A	(Dental)	$22.62	$23.70	$27.12	$29.47
C	(Social workers)	3.47	3.64	4.16	4.52
D	(Therapy)	6.22	6.51	7.45	8.10
I	(Eye exams)	15.89	16.65	19.05	20.70
L	(Thermography)
-Medical Doctor	44.55	46.67	53.41	58.04
-Dentist	44.55	46.67	53.41	58.04
-Chiropractic Doctor	42.33	44.35	50.75	55.14

To determine the maximum allowable fee for a procedure, it is necessary to multiply the unit value by the conversion factor.

Example: If the dental procedure designated as procedure 02510 in the dental fee schedule is performed in Region II, the maximum allowable fee is determined by multiplying the unit value, 8.5, by 23.70, the dental conversion factor, i.e., 8.5 x 23.70 = 201.45.

POSTAL ZIP CODES INCLUDED IN EACH REGION

Region I

*From*	*Thru*
12007 .......	12099
12106 .......	12177
12184 .......	12199
12401 .......	12498
12701 .......	12792
12801 .......	12887
12901 .......	12998
13020 .......	13094
13101 .......	13167
13301 .......	13368
13401 .......	13439
13441 .......	13495
13601 .......	13698
13730 .......	13797
13801 .......	13865
14001 .......	14098
14101 .......	14174
14301 .......	14305
14410 .......	14489
14501 .......	14592
14701 .......	14788
14801 .......	14898
14901 .......	14905

Region II

*From*	*Thru*
12180 .......	12183
12201 .......	12257
12301 .......	12345
12501 .......	12594
12601 .......	12614
13201 .......	13260
13440 .......	-
13501 .......	13503
13901 .......	13905
14201 .......	14265
14601 .......	14692

Region III

*From*	*Thru*
10501 .......	10598
10601 .......	10650
10701 .......	10710
10801 .......	10805
10901 .......	10998
11901 .......	11980

Region IV

*From*	*Thru*
10001 .......	10099
10301 .......	10314
10401 .......	10475
11001 .......	11050
11101 .......	11111
11201 .......	11252
11301 .......	11390
11401 .......	11460
11501 .......	11598
11601 .......	11697
11701 .......	11798
11801 .......	11819

NUMERICAL LIST OF POSTAL ZIP CODES

*From*	*Thru*	*Region*
10001	10099	IV
10301	10314	IV
10401	10475	IV
10501	10598	III
10601	10650	III
10701	10710	III
10801	10805	III
10901	10998	III
11001	11050	IV
11101	11111	IV
11201	11252	IV
11301	11390	IV
11401	11460	IV
11501	11598	IV
11601	11697	IV
11701	11798	IV
11801	11819	IV
11901	11980	III
12007	12099	I
12106	12177	I
12180	12183	II
12184	12199	I
12201	12257	II
12301	12345	II
12401	12498	I
12501	12594	II
12601	12614	II
12701	12792	I
12801	12887	I
12901	12998	I
13020	13094	I
13101	13167	I
13201	13260	II
13301	13368	I
13401	13439	I
13440	-	II
13441	13495	I
13501	13503	II
13601	13698	I
13730	13797	I
13801	13865	I
13901	13905	II
14001	14098	I
14101	14174	I
14201	14265	II
14301	14305	I
14410	14489	I
14501	14592	I
14601	14692	II
14701	14788	I
14801	14898	I
14901	14905	I

Part A. Dental fee schedule.

[Reserved]

Part B. Private nursing services fee schedules.

(a) Registered professional nurses. The maximum permissible charge for private nursing services is the local prevailing charge for such services.

(b) Licensed practical nurses. The maximum permissible charge for private nursing services Is the local prevailing charge for such services.

Part C. Psychiatric social worker fee schedule.

The maximum permissible charge for any duly licensed psychiatric social worker's services is the product of the unit value shown in the following schedule and the regional conversion factor set forth in this Part. For psychiatric services performed by a physician, see the Workers' Compensation medical fee schedule.

*Psychiatric social worker services*	*Unit value*
Office visit, 50 minutes (prorated)	16.0
Home visit, 50 minutes (prorated)	17.5
Group therapy, per recipient (maximum 8 persons per group)
45-50 minutes, office	4.0
90 minutes, office	6.4

PART C

REGIONAL CONVERSION FACTORS

(Effective September 1, 1994)

Region¹	*Regional conversion factor*
I	$3.47
II	3.84
III	4.16
IV	4.52

Psychological fee schedule. Please refer to the Workers' Compensation psychology fee schedules.

Part D. Speech therapy fee schedule.

The maximum permissible charge for any service performed by a qualified speech therapist is the product of the unit value shown in the following schedule and the regional conversion factor set forth in this Part. For physical and occupational therapy, see the Workers' Compensation medical fee schedule.

*Therapy services*			*Unit value*
1.	Therapy sessions at a clinic, hospital outpatient department or therapist's office:
		Individual therapy session:		30 minutes or less	4.70
			more than 30 minutes	6.40
	Group therapy session, per patient:
	Group of two:	90 minutes or less		6.42
			more than 90 minutes		8.74
	Group of three:	90 minutes or less		4.70
			more than 90 minutes		6.40
	Group of four:	90 minutes or less		3.75
			more than 90 minutes		5.11
2.	Comprehensive evaluation and written report by a speech pathologist		9.8

PART D

REGIONAL CONVERSION FACTORS

(Effective September 1, 1994)

Region¹	*Regional conversion factor*
I	$6.22
II	6.51
III	7.45
IV	8.10

Part E.

¹ The Official New York Workers' Compensation Durable Medical Equipment Fee Schedule ("Fee Schedule"), published by the New York State Workers' Compensation Board, is hereby incorporated by reference in this Part. The Fee Schedule is readily available without charge at the following internet address: https://www.wcb.ny.gov/content/main/hcpp/FeeSchedules.jsp. The Fee Schedule is also available from the New York State Department of Financial Services, One State Street, New York, NY 10004.

Part F. [Reserved]

Part G. Ambulance and other common carrier transportation.

(a) The maximum permissible charge for ambulance service is the local prevailing charge for such service.

(b) The maximum permissible charge for other common carrier transportation is the local prevailing charge for such service, based on the most direct route.

Part H. Hearing aid supplies and services.

The maximum permissible charge for hearing aid supplies and services is the actual cost of the hearing aid to the provider, plus:

(a) in the case of a monaural instrument, a dispensing fee of $266;

(b) in the case of a binaural instrument, a dispensing fee of $344.

Part I. Eye examinations and related services fee schedule.

The maximum permissible charge for eye examinations or related services performed by an optometrist is the product of the unit value shown in the following schedule and the regional conversion factor set forth below:

*Optometric services*	*Unit value*
Eye examination, with refraction and prescription for glasses, if required	2.32
Clinical services:
One-hour session:	3.63
Two-hour session:	5.77

(For eye examinations and other professional services performed by an ophthalmologist, see the section labeled Ophthalmological Diagnostic and Treatment Services, starting with Code 92002 in the Workers' Compensation medical fee schedule.)

PART I

REGIONAL CONVERSION FACTORS

(Effective September 1, 1994)

Region¹	*Regional conversion factor*
I	$15.89
II	16.65
III	19.05
IV	20.70

Part J. Eyeglasses fee schedule.

(a) The maximum permissible charge for providing and fitting eyeglasses shall be equal to the sum of:

(1) the actual cost of the frames to the provider, not to exceed $27[DAGGER], plus a dispensing fee of $28; and

(2) a charge for obtaining and dispensing lenses, not to exceed $51 for single vision lenses, $82 for bifocal lenses, and $97 for trifocal lenses.

(b) The maximum permissible charge for providing contact lenses, including dispensing fee, shall be:

(1) hard contact lenses--$148; and

(2) soft contact lenses--$246.

This limitation shall not apply when the frames are identical to or substantially the same design and cost as frames damaged, lost, or otherwise requiring replacement as a result of an automobile accident; in such case, the maximum permissible charge is the actual cost of the frames to the provider, plus a $28 dispensing fee.

Part K. Fee schedule for services rendered in accordance with a religious method of healing. The maximum permissible charge for nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of the State of New York, by a practitioner accredited to provide such care and treatment is $27 per day.

[FN1] Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal ZIP codes contained in the introduction to Appendix 17-C.

N.Y. Comp. Codes R. & Regs. tit. 11, Appendices, app 17-C

Amended New York State Register January 11, 2023/Volume XLIV, Issue 2, eff. 12/23/2022

Amended New York State Register February 15, 2023/Volume XLIV, Issue 07, eff. 2/15/2023

Amended New York State Register October 23, 2024/Volume XLVI, Issue 43, eff. 10/23/2024