N.Y. Comp. Codes R. & Regs. tit. 12 § 329-1.3
Current through Register Vol. 46, No. 19, May 8, 2024
Section 329-1.3 - Medical fee schedule; incorporation by reference(a) The medical fee schedule for medical services shall be the Official New York Workers' Compensation Medical Fee Schedule, updated December 11, 2019, prepared by the board and published by OptumInsight, which is herein incorporated by reference.(b) 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 OptumInsight, 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/(c) Authorized providers who utilize the Official New York State Workers' Compensation Fee Schedule shall use the following Common Procedural Technology (CPT) codes when telemedicine is used in accordance with section 325-1.8 of this Title. Use of these codes are limited to one unit per patient per day. Use of these codes are not eligible for the enhanced reimbursement set forth in Modifiers in 1B or 1D of Ground Rule 9. (1) 99441 (telephone evaluation and management services provided to an established patient; 5-10 minutes of medical discussion); (2) 99442 (telephone evaluation and management services provided to an established patient; 11-20 minutes of medical discussion); and (3) 99443 (telephone evaluation and management services provided to an established patient; 21-30 minutes of medical discussion).(d) When workers' compensation benefits are sought due to a workplace exposure to COVID-19, reimbursement for serological, molecular or other reliable testing to confirm a current COVID-19 viral infection may be made using CPT code 87635. (1) The RVU for CPT code 87635 shall be 39.18, and the total fee for such test shall be 51.33 for Region IV, 47.41 for Region III, and 41.53 for Regions I and II.(2) CPT code 87635 may only be billed when there is a claim for workers' compensation due to a COVID-19 infection as a result of a workplace exposure or when testing for COVID-19 is administered as part of a required pre-operative testing protocol in accordance with Department of Health guidance.(3) CPT code 87635 may not be billed for routine screening of workers' compensation claimants for the presence of the COVID-19 virus.(4) Antibody testing is not available under the Official New York Workers' Compensation Fee Schedule.(5) CPT code 87635 may only be billed in one instance. Repeat testing is not permitted, except when clinical documentation supports a change or reoccurrence of symptoms, or a new exposure to the COVID-19 virus.N.Y. Comp. Codes R. & Regs. Tit. 12 § 329-1.3
Renumbered from 329.3 New York State Register December 30, 2015/Volume XXXVII, Issue 52, eff. 12/30/2015Amended New York State Register December 26, 2018/Volume XL, Issue 52, eff. 4/1/2019Amended New York State Register December 11, 2019/Volume XLI, Issue 50, eff. 1/1/2020Amended New York State Register April 1, 2020/Volume XLII, Issue 13, eff. 3/16/2020Amended New York State Register April 7, 2021/Volume XLIII, Issue 14, eff. 4/7/2021Amended New York State Register April 26, 2023/Volume XLV, Issue 17, eff. 4/11/2023