N.Y. Comp. Codes R. & Regs. Tit. 12 § 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.
Notes
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