N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-3.1

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

Section 329-3.1 - Schedule of rates for hospital emergency room services

The fee schedule applicable to hospital emergency room services shall be one hundred fifty percent of the Department of Health's EAPG Base Rates Fees as published on the table of EAPG Weights, Procedure Based Weights and Units on the Department of Health's website, as described in (a) and (b) below, and payable under the enhanced ambulatory patient grouping (EAPG) methodology governing reimbursement for hospital emergency department services on the date the emergency room services were rendered regardless of the date of accident or disability and, as set forth herein and subject to WCB specific adjustments.

(a) EAPG methodology means the methodology developed and published by Minnesota Mining and Manufacturing Corporation (3M), including the software developed to process CPT-4 and ICD-10 code information to assign patient visits to the appropriate EAPG category or categories and apply appropriate bundling, packaging, consolidation and discounting to assign the appropriate final EAPG weight and associated reimbursement.

(b) The table of EAPG Weights, Procedure Based Weights and Units, and EAPG Fee Schedule fees and units for each effective period are published on the New York State Department of Health website at: http://www.health.state.ny.us/health_care/medicaid/rates/apg/docs/ apgpaymentcomponents.xls and are herein incorporated by reference. Copies of the EAPG Fee Schedule fees and units may be downloaded without cost. Hard copies can also be requested by email at GENERAL_INFORMATION@wcb.ny.gov or by submitting a request in writing to the New York State Workers' Compensation Board, 328 State Street, Schenectady, New York 12305-2318.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-3.1

Renumbered from 329.6 New York State Register December 30, 2015/Volume XXXVII, Issue 52, eff. 12/30/2015

Amended New York State Register May 1, 2019/Volume XLI, Issue 18, eff. 6/1/2019