For those of you keeping track, the New York State Workers’ Compensation Board has issued a new fee schedule.
It can be purchased from the official publisher here: https://www.optum360coding.com/Product/48505/
That fee schedule has traditionally applied to the New York State no-fault system by operation of insurance regulation 83.
Some of the specific changes in the new fee schedule have caused concern to a number of no-fault practitioners throughout New York State.
Generally, there are changes in the fee schedule that would work very well in the Workers Compensation system, that have the potential to throw the No-Fault system into chaos.
In an attempt to reduce or eliminate much of that chaos, the Department of Financial Services has issued an emergency adoption of an amendment to the No-Fault regulations regarding this new fee schedule.
It is officially the Thirty-Fourth Amendment to Part 68 of Title 11 of the Official Compilation of Codes, Rules and Regulations of the State of New York (Insurance Regulation 83).
You can read it here: https://www.dfs.ny.gov/insurance/r_emergy/re34text83.pdf
That amendment to the regulations states clearly that the changes to the amounts that providers can charge for services will not impact the No-Fault system until providers are billing for services rendered on and after October 1, 2020.
The text of the new amendment comes with some explanatory publications: https://www.dfs.ny.gov/insurance/remgindx.htm
Part of those explanations is the regulatory impact statement here: https://www.dfs.ny.gov/insurance/r_emergy/re34sapa.pdf
In the second paragraph on page three of that statement the Department of Financial Services makes clear that some of the ground rules listed in the new fee schedule will take effect in April of this year.
Ground Rule 10 of the Chiropractic Fee Schedule
Ground Rule 13 of the Behavioral Health Fee Schedule
Ground Rule 16 of the Podiatry Fee Schedule
All three of these rules limit those professionals from billing for CPT codes outside of their individual fee schedule.
There is also Ground Rule 19 of the Medical Fee Schedule which prohibits any chiropractor, podiatrist, or provider of behavioral health from billing for CPT codes in the medical fee schedule.
There is also the question of time limits…
The same regulatory impact statement makes clear that the time limits for providing services in the fee schedule do not apply to no-fault providers.
That provision can be found in the last paragraph of the actual amendment, cited above.
Also, General Medicine specialists are getting a 20% increase in fees in the Workers Compensation system, and not the No-Fault system.