reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-2 - Ambulatory Surgery Services Fee Schedule › Section 329-2.1 - Scope and Effective Date

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except
					 as set forth in subdivision (b) herein, payment for ambulatory surgery services
					 shall be made according to the ambulatory patient group s (APG) methodology,
					 governing reimbursement for licensed freestanding ambulatory surgical centers
					 and hospital-based ambulatory surgery services as set forth herein and subject
					 to WCB specific adjustments. The effective date of this Subpart shall be
					 October 1, 2015.
(b) The following
					 services performed at licensed freestanding ambulatory surgical centers and
					 hospital-based ambulatory surgery services on or after March 15, 2021 shall not
					 be subject to APG methodology, but shall be reimbursed at the following rates:
CPT
Description
Fee
23472
Arthroplasty Shoulder Total
$7,723.47
23615
FX Proximal Humerus Open TX W/Wo
									 Fixation
$5,869.06
24363
Arthroplasty Elbow Total
$7,723.47
24666
FX Radial Head/Neck Open TX W/Radial Head
									 Prosthetic Replacement
$6,369.06
24685
Olecranon fracture ORIF
$5,869.06
25446
Arthroplasty Wrist Total
$7,723.47
25574
FX Radial and Ulnar Shaft Open TX W/Fixation
									 Radius or Ulna
$5,869.06
25575
FX Radial and Ulnar Shaft Open TX W/Fixation
									 Radius & Ulna
$5,869.06
25607
FX Distal Radial Extra-Articular Open TX
									 W/Internal Fixation
$5,869.06
25608
2 and 3 distal radius fractures
$5,869.06
25609
3 and distal radius fractures
$5,869.06
25825
Arthrodesis Wrist Limited
									 W/Autograft
$4,461.63
27130
Arthroplasty Hip Total
$7,723.47
27132
Conversion Previous Hip SX to Total Hip
									 Replacement
$7,723.47
27447
Arthroplasty Knee Total
$7,723.47
27486
Revise Total Knee Arthroplasty One
									 Component
$7,723.47
27702
Arthroplasty Ankle Total
$7,723.47
27703
Arthroplasty Ankle Revision Total
									 Ankle
$7,723.47
27792
FX Lateral Malleolus (Distal Fibula) Open TX
									 W/Wo Fixation
$5,869.06
27823
Open reduction internal fixation of
									 trimalleolar Fracture
$5,869.06
27870
Ankle Arthrodesis
$5,311.97
28299
Hallux Valgus Correction by Double
									 Osteotomy
$5,449.85
28615
Open reduction of tarsometatarsal
									 dislocations
$5,869.06
28715
Trip Arthrodesis
$4,949.85
28725
Subtalar Arthrodesis
$4,949.85
28730
Tarsometatarsal Arthrodesis
$4,949.85
28740
Tarsometatarsal Arthrodesis
$4,949.85
29827
Arthroscopy Shoulder W/Rotator Cuff
									 Repair
$6,723.47
29888
Arthroscopy Ant Cruciate Ligament Repair/
									 Augment Reconstruction
$6,677.77
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-2 - Ambulatory Surgery Services Fee Schedule › Section 329-2.3 - APGs, Relative Weights, and system updating

Current through Register Vol. 46, No. 28, July 10, 2024
The table of APG Weights, Procedure Based Weights and
						units, and APG 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/
						apg_payment_components.xls
and are herein incorporated by
						reference.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-2 - Ambulatory Surgery Services Fee Schedule › Section 329-2.4 - Diagnostic coding and rate computation

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
					 Facility shall assign ICD-10 diagnostic and HCPCS/CPT-4 procedure codes for
					 each visit and shall utilize the claim coding information to assign the
					 applicable APG. The facility shall use the APG software system to determine the
					 significant procedure APG, applicable ancillary services APGs and the final
					 weight for a visit. The APG software system shall incorporate methodologies for
					 consolidation, packaging and discounting to be reflected in the final weight to
					 be assigned to the claim.
(b) Other
					 applicable adjustments shall be made by the facility.
(c) Bill in accordance with APG requirements
					 and WCB adjustments submitted for reimbursement to Payer with a copy to
					 WCB.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-2 - Ambulatory Surgery Services Fee Schedule › Section 329-2.5 - System updating and incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 following elements of the APG rate-setting system shall be updated no less
					 frequently than annually:
(1) the listing of
					 reimbursable APGs subject to this Subpart and the relative weight assigned to
					 each such APG;
(2) the Workers'
					 Compensation specific base rates;
(3) the applicable ICD-10 codes utilized in
					 the APG software system;
(4) the
					 applicable CPT-4/HCPCS codes utilized in the APG software system;
(5) the APG software system
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-3 - Emergency Room, Hospital-based Mental-health Clinic Services, and Rural Outpatient Clinic Services Fee Schedule › Section 329-3.1 - Schedule of rates for hospital emergency room services

Current through Register Vol. 46, No. 28, July 10, 2024
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.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-3 - Emergency Room, Hospital-based Mental-health Clinic Services, and Rural Outpatient Clinic Services Fee Schedule › Section 329-3.2 - Outpatient hospital services schedule

Current through Register Vol. 46, No. 28, July 10, 2024
[See Appendix C-6, infra.]
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-3 - Emergency Room, Hospital-based Mental-health Clinic Services, and Rural Outpatient Clinic Services Fee Schedule › Section 329-3.3 - Schedule of Rates for Rural Outpatient Clinics

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For the purposes of this section, Rural
					 Outpatient Clinic means a medical clinic (i) which is located in a rural area
					 that meets the definition of a Health Professional Shortage Area, as defined in
					 section 254e of Title 42 of the U.S. Code; and (ii) and is listed at
					 https://data.hrsa.gov/tools/shortage-area/hpsa-find as a facility located in
					 New York State, offering primary care services in an area identified as rural
					 or partially rural with a HPSA score of 15 to 26.
(b) The fee schedule for Rural Outpatient
					 Clinic facility services shall be the fees for Clinics in the Upstate region on
					 the date the service is rendered and as published on the New York State
					 Department of Health website at:
					 https://www.health.ny.gov/healthcare/medicaid/rates/apg/rates/hospital/hospbaserates5-2-15.htm
					 and such fees shall be payable upon submission of proof of the Health
					 Professional Shortage Area qualification set forth in subdivision (a) herein on
					 the date of service.
(c) Such fees
					 shall be in addition to fees payable pursuant to Subpart 329-1 of this Part
					 (Medical Fee Schedule).
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-3 - Emergency Room, Hospital-based Mental-health Clinic Services, and Rural Outpatient Clinic Services Fee Schedule › Section 329-3.4 - Schedule of Rates for Outpatient Hospital Based Mental Health Clinics and Private Psychiatric Hospitals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Outpatient Hospital Based Mental Health
					 Clinics
1. means a mental health clinic
					 associated to a hospital that possesses the required operating certificate
					 under Article 31 of the Mental Hygiene Law as required by subdivision (a)(2) of
					 section 31.02 of that Article when such Clinic provides medical care and
					 treatment to workers' compensation claimants by a Board authorized
					 psychiatrist, psychologist or physician with a rating code of PN-ADP (Addiction
					 Medicine) or PN-PM (Pain Management) or under the active and personal
					 supervision of a Board authorized psychiatrist or Board authorized physician
					 with a rating code of PN-ADP (Addiction Medicine) or PN-PM (Pain
					 Management).
2. The fee schedule
					 for Hospital Based Mental Health Clinic facility services shall be the APG Peer
					 Group Base Rates on the date the service is rendered and as published on the
					 New York State Office of Mental Health website at:
					 https://www.omh.ny.gov/omhweb/medicaidreimbursement/
3. Such fees shall be in addition to fees
					 payable pursuant to Subpart 329-1 of this Part (Medical Fee Schedule) and
					 section
					 333.2 
					 of this Chapter (Behavioral Health Fee Schedule).
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-4 - Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule › Section 329-4.1 - Application

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The fee
					 schedule applicable to acupuncture services shall be the acupuncture fee
					 schedule in effect on the date on which the acupuncture services were rendered,
					 regardless of the date of accident.
(b) The fee schedule applicable to physical
					 therapy and occupational therapy services shall be the physical therapy and
					 occupational therapy fee schedule in effect on the date on which the physical
					 therapy or occupational therapy services were rendered, regardless of the date
					 of accident.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 329 - Medical, Outpatient And Ambulatory Surgery Services Fee Schedules › Subpart 329-4 - Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule › Section 329-4.2 - Acupuncture and physical therapy and occupational therapy fee schedule; incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 acupuncture fee schedule for acupuncture services shall be the Official New
					 York Workers' Compensation Acupuncture and Physical Therapy and Occupational
					 Therapy Fee Schedule, created Dec ember 11, 2019 prepared by the Board and
					 published by OptumInsight, which is herein incorporated by reference.
(b) The physical therapy and
					 occupational therapy fee schedule for physical therapy and occupational therapy
					 services shall be the Official New York Workers' Compensation Acupuncture and
					 Physical Therapy and Occupational Therapy Fee Schedule, created December 11,
					 2019, prepared by the Board and published by OptumInsight, which is herein
					 incorporated by reference.
(c) The
					 Official New York Workers' Compensation Acupuncture and Physical Therapy Fee
					 Schedule incorporated by reference he rein 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 88 050, 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/
.
(d) Authorized acupuncturists, physical
					 therapists, and occupational therapists shall use Common Procedural Technology
					 (CPT) code 99441 (telephone evaluation and management services provided to an
					 established patient; 5-10 minutes of medical discussion) when telemedicine is
					 used in accordance with section
					 325-1.8  of
					 this Title, notwithstanding this code not appearing in the Official New York
					 Workers' Compensation Acupuncture and Physical Therapy and Occupational Therapy
					 Fee Schedule. Use of this code is limited to one unit per patient per
					 day.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.1 - Application to practice psychology

Current through Register Vol. 46, No. 28, July 10, 2024
Application by a duly licensed psychologist of the State of
					 New York to practice under the Workers' Compensation Law shall be made upon a
					 form furnished by the chair and shall be filed with the Psychology Practice
					 Committee, Workers' Compensation Board, Health Provider Administration, 100
					 Broadway-Menands, Albany, NY 12241. Such application shall state, fully and
					 truthfully, all the information required by law, and the applicant shall make
					 and sign the statutory agreement. The chair shall notify the psychologist of
					 approval of his or her application within 60 days after receipt by the chair of
					 a recommendation for approval from the Psychology Practice
					 Committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.2 - Investigation of application

Current through Register Vol. 46, No. 28, July 10, 2024
Upon the filing of such application, the Psychology
					 Practice Committee shall investigate and pass upon the same within 60 days of
					 such filing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.3 - Notification to applicant of disapproval

Current through Register Vol. 46, No. 28, July 10, 2024
Upon refusal to recommend approval of an application for
					 authority to practice, the Psychology Practice Committee shall notify the
					 applicant, in writing, of such refusal.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.4 - Investigation and hearing procedure

Current through Register Vol. 46, No. 28, July 10, 2024
In any investigation or hearing conducted before the
					 Psychology Practice Committee pertaining to the revocation or suspension of the
					 authority of a psychologist as provided under the Workers' Compensation Law,
					 the following rules of procedure shall apply:
(a) The accused psychologist shall be given
				  30 days notice, in writing, containing a brief statement of the charge or
				  charges against such psychologist and the time and place where such charge or
				  charges will be heard. Such notice shall be served either personally or by
				  mail. At least 10 days prior to the return date in said notice, the accused
				  psychologist shall file an answer with the Psychology Practice Committee,
				  answering the charges contained therein.
(b) On the hearing of such charge or charges,
				  the accused psychologist shall be entitled to be represented by counsel and to
				  cross-examine witnesses. Witnesses shall be placed under oath. A verbatim
				  record of the proceedings shall be made.
(c) A true copy of the record of each
				  proceeding shall be submitted to the chair along with the report, findings and
				  recommendation of the Psychology Practice Committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.5 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The Psychology Practice Committee conducting a hearing
					 shall not be bound by common law or statutory rules of evidence, or by
					 technical or formal rules of procedure, except as provided in this Subchapter,
					 but may make such investigation or inquiry, or conduct such hearing, in such
					 manner as it deems advisable and necessary.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.6 - Decision of committee

Current through Register Vol. 46, No. 28, July 10, 2024
The Psychology Practice Committee shall consist of three
					 members, two of whom shall constitute a quorum and may proceed with the
					 transaction of such business as may come before them, and a decision by a
					 majority of the committee shall be deemed the decision of the entire
					 committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 330 - Procedure Before Psychology Practice Committee › Section 330.7 - Committee chair and secretary

Current through Register Vol. 46, No. 28, July 10, 2024
The chair shall designate a member of the Psychology
					 Practice Committee to serve as chair of the committee, and shall also appoint a
					 secretary of such committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.1 - Limitation of psychology treatment

Current through Register Vol. 46, No. 28, July 10, 2024
A psychologist who is authorized to treat workers'
					 compensation claimants shall be limited, pursuant to law, to the diagnosis,
					 evaluation and treatment of mental, nervous, emotional and behavioral disorders
					 and illnesses, and shall render such treatment only within the field of his or
					 her professional competence as recognized by his or her
					 profession.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.2 - Report of attending psychologist

Current through Register Vol. 46, No. 28, July 10, 2024
The attending psychologist shall obtain from the claimant a
					 complete history of the claimant's injury or condition and shall report this to
					 the chair, together with a full report of the known injury or condition as
					 determined by his or her examination and diagnosis, as well as of any other
					 injury or condition. Known injury or condition includes any condition the
					 existence of which is ascertainable through psychological diagnosis and
					 evaluation. Reported injury or condition includes any condition the existence
					 of which is ascertainable either visually or from an authoritative source, such
					 as the claimant, employer, a physician, etc. The report of injury or condition
					 so ascertained shall not be deemed to constitute a professional diagnosis or
					 opinion.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.3 - Filing of reports

Current through Register Vol. 46, No. 28, July 10, 2024
In order to expedite the processing of claims of disabled
					 workers and to avoid, so far as possible, the appearance of psychologists in
					 contested bill proceedings, the rules with respect to the filing of
					 psychological reports by an attending psychologist are here stated:
(a) All psychological reports filed by an
				  attending psychologist must contain the psychologist's authorization
				  certificate number.
(b) Every
				  psychologist shall file the following reports directly with the chair, and also
				  with the employer or the employer's carrier, if known:
(1) within 48 hours following first
				  treatment, a 48-hour preliminary report;
(2) within 15 days after filing the 48-hour
				  preliminary report and in no event later than 17 days after first treatment, a
				  15-day report giving a complete report of injury and treatment;
(3) thereafter and during continuing
				  treatment and without further request, a progress report at intervals of 45
				  days or less;
(4) immediately upon
				  termination of treatment, a final report regardless of the date the last
				  previous report was filed, except that where treatment is terminated within 48
				  hours following first treatment, the 48-hour preliminary report shall
				  constitute the final report if so noted thereon; and
(5) additional or more frequent reports when
				  requested by the chair and within three workdays after such request is
				  made.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.4 - Required authorization

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No
				  claim for payment for biofeedback treatments shall be valid and enforceable as
				  against the employer or its carrier or the special fund under section 25-a  of
				  the Workers' Compensation Law, unless such treatment is required in an
				  emergency or shall have been authorized by the employer or its carrier or, in
				  cases under section 25-a, the chair.
(b) Where a claimant has been referred by an
				  authorized physician to a psychologist for evaluation purposes only and not for
				  treatment, prior authorization shall be required if the cost of such
				  consultation shall exceed $1,000.
(c) All rules and procedures of the chair,
				  relating to authorization for special services as set forth in section
				  325-1.4 
				  of this Title are made applicable to requests for authorization for, and
				  performance of, the services set forth in subdivisions (a) and (b) of this
				  section, and any special diagnostic laboratory tests which may be performed by
				  psychologists, to the extent they are not inconsistent with the provisions of
				  section 13-m  of the Workers' Compensation Law and the other rules duly
				  promulgated thereunder.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.5 - Duties of succeeding psychologist

Current through Register Vol. 46, No. 28, July 10, 2024
A psychologist authorized to treat workers' compensation
					 cases, when requested to supersede another psychologist or a physician, must,
					 before beginning treatment, make reasonable effort to communicate, after
					 obtaining the consent of the patient (or guardian), with the attending
					 psychologist or the physician to ascertain the patient's condition and whether
					 or not there is any injury or condition other than mental, nervous, emotional
					 and behavioral disorders and illnesses. The superseding psychologist must also
					 advise the attending psychologist or physician of the name of the person who
					 has requested him or her to assume care of the case and state the reason
					 therefor. If the superseding psychologist cannot contact the attending
					 psychologist or physician, and the claimant's condition is such as to require
					 immediate treatment, the superseding psychologist should advise the
					 psychologist or physician previously in attendance, within 48 hours, that he or
					 she now has the patient in his or her care and send a copy of such notice to
					 the employer or carrier and to the chair. The superseding psychologist or
					 physician shall supply the superseding psychologist with a complete history of
					 the case.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.6 - Advertising

Current through Register Vol. 46, No. 28, July 10, 2024
All rules and procedures of the chair relating to
					 advertising by a physician as set forth in section
					 325-1.16 
					 of this Title are made applicable to psychologists, to the extent that they are
					 not inconsistent with the provisions of section 13-m  of the Workers'
					 Compensation Law and the other provisions duly promulgated
					 thereunder.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.7 - Carriers not to supply names of authorized psychologists

Current through Register Vol. 46, No. 28, July 10, 2024
Insurance carriers shall not supply names of authorized
					 psychologists to their policyholders. Employers may secure a list of all
					 authorized psychologists in the vicinity of their places of business by
					 applying to the chair.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.8 - Psychologist fees for hearing purposes

Current through Register Vol. 46, No. 28, July 10, 2024
A psychologist who testifies at hearings or examines
					 claimants or participates in examination for evidential material for
					 compensation case hearings purposes only, without treatment, may accept fees
					 for such services from the claimant, employer or carrier requesting the
					 examination.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.9 - Carrier's or employer's consultant not to treat employee

Current through Register Vol. 46, No. 28, July 10, 2024
No psychologist who examines for an insurance carrier or an
					 employer or is a psychology consultant for the carrier or employer in the case
					 of an injured employee, shall subsequently participate in the psychological
					 care of such injured employee. Nothing herein contained shall affect the right
					 of transfer by written consent of the injured employee, and the superseding
					 psychologist shall comply with the provisions of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 331 - Psychology Treatment And Care › Section 331.10 - Examination procedure

Current through Register Vol. 46, No. 28, July 10, 2024
When an examination is performed under subdivision (4) of
					 section 13-m  of the Workers' Compensation Law, it shall be by a qualified
					 psychologist at a place reasonably convenient to the claimant and in the
					 presence of the claimant's psychologist or physician, if in the attending
					 psychologist's or physician's opinion his or her presence is necessary. A
					 duplicate copy of all notices of request for such examinations shall be sent to
					 the attending psychologist or physician.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chair refers to
				  the chairman, chairwoman or chair of the Workers' Compensation Board of the
				  State of New York.
(b) Carrier
				  refers to the employer or its insurer.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.2 - Notice of objection to bill

Current through Register Vol. 46, No. 28, July 10, 2024
Notice of objection by a carrier to any bill for
					 psychological care shall be given to the chair in duplicate, and two copies
					 thereof given to the psychologist whose bill is in dispute, within 30 days
					 after such bill has been rendered, on the form (A-1) prescribed by the chair
					 for such purpose. Where compensability of the claim is controverted and has not
					 yet been determined, or where other issues requiring Workers' Compensation
					 Board determination are interposed as reasons for nonpayment of the bill, the
					 notice of objection shall so state.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.3 - Psychologist's decision regarding arbitration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon receipt of such notice of objection
				  (form A-1), the psychologist may request arbitration by notifying the chair in
				  accordance with the following:
(1) if only
				  arbitration issues are raised, the request for arbitration shall be made within
				  60 days after receipt of the notice of objection (A-1);
(2) if there are issues requiring
				  adjudication by a Workers' Compensation Law judge in addition to arbitration
				  issues, the request for arbitration shall be made within 60 days of the filing
				  of the decision in favor of the psychologist; and
(3) failure to make timely request for
				  arbitration shall be deemed a waiver of the right to arbitration.
If the psychologist wishes to arbitrate the bill, he or she
					 shall complete and sign the request for arbitration and forward it to the
					 Psychology Practice Committee, together with a check to the order of the Chair,
					 Workers' Compensation Board, in the sum of $5 as a minimum expense fee.
					 Notwithstanding any provision in this section to the contrary, upon application
					 of the psychologist, the chair may for good cause shown excuse the psychologist
					 for delay in filing the request for arbitration, and schedule the disputed bill
					 for arbitration.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.4 - Date of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The Psychology Practice Committee shall prepare a calendar
					 of disputed bills and shall arrange a time and place of hearing. At least 30
					 days prior to the date set for hearing, notice thereof shall be mailed to the
					 psychologist and carrier, advising the date, time and place of the
					 hearing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.5 - Withdrawal of objection; settlement

Current through Register Vol. 46, No. 28, July 10, 2024
A carrier may file with the chair, not later than the 10th
					 day prior to the date set for hearing, a withdrawal of objection on a form
					 (A-3) prescribed by the chair for such purpose, in which event the chair will
					 refund to the psychologist the $5 expense fee paid by him or her. If the
					 parties to the dispute settle their differences within 10 days prior to the
					 date set for hearing, notice of settlement on a form (A-4) prescribed by the
					 chair for such purpose shall be signed by all parties and filed with the chair
					 on or before the date set for the hearing. The parties to such a settlement
					 shall each pay to the chair a minimum expense fee of $5 in the manner provided
					 in section
					 332.8 
					 of this Part.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.6 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The Psychology Practice Committee shall not be bound by
					 common law or statutory rules of evidence, or by technical or formal rules of
					 procedure, but may make such investigation or inquiry and conduct its hearing
					 in such a manner as it deems proper and necessary in the premises. The
					 Psychology Practice Committee may, in the event of nonappearance, decide the
					 value of the disputed bill on the basis of the evidence before it. Said hearing
					 may be held by one or more of the members of the Psychology Practice
					 Committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.7 - Decision

Current through Register Vol. 46, No. 28, July 10, 2024
The decision of the Psychology Practice Committee may be
					 made in executive session. In arriving at a determination, the decision of two
					 members of the Psychology Practice Committee shall constitute the decision of
					 the committee, and be binding upon the parties, The decision or determination
					 shall be signed by members of the Psychology Practice Committee making the
					 decision, and shall be filed with the record of the case. Copies of notice of
					 decision shall be mailed to the parties to the dispute.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.8 - Payment of fees and award

Current through Register Vol. 46, No. 28, July 10, 2024
The parties to disputed psychology bill proceedings shall
					 each pay to the chair a sum equal to five per centum of the amount payable
					 under such decision or $5, whichever is greater. If there is no amount payable
					 under such decision, or if the disputed bill is determined by notice of
					 settlement (A-4), each party to the proceeding shall pay to the chair a minimum
					 expense fee of $5. The sum so collected shall be transferred to the State
					 Treasury to reimburse it on account of the expense of administration. Payment
					 pursuant to the decision of the Psychology Practice Committee shall be made as
					 follows:
(a) If the amount of the bill
				  awarded under a decision other than a notice of settlement (A-4) is more than
				  $100, the carrier shall promptly:
(1) pay to
				  the psychologist the amount directed in the award and decision, less the
				  balance of the expense fee of five per centum due from the psychologist;
				  or
(2) pay to the chair an expense
				  fee due from the carrier of five per centum of the amount directed in the award
				  and decision, plus the balance of the expense fee due from the psychologist and
				  deducted pursuant to paragraph (1) of this subdivision.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 332 - Examination Of Disputed Psychology Bills › Section 332.9 - Filing of notice

Current through Register Vol. 46, No. 28, July 10, 2024
All notices required to be filed with the chair pursuant to
					 this Subchapter shall be deemed filed when received by the Chair, Workers'
					 Compensation Board, 180 Livingston Street, Brooklyn, NY
					 11248.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 333 - Psychology Fee Schedule › Section 333.1 - Application

Current through Register Vol. 46, No. 28, July 10, 2024
The fee schedule applicable to psychological services shall
					 be the behavioral health fee schedule in effect on the date on which the
					 psychological services were rendered, regardless of the date of
					 accident.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter D - Psychology Treatment And Care › Part 333 - Psychology Fee Schedule › Section 333.2 - Behavioral Health fee schedule; incorporation by reference

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The behavioral health fee schedule for
				  psychology services shall be the Official New York Workers' Compensation
				  Behavioral Health 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 Behavioral Health 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 88 050, Chicago,
				  IL 60680-9920; by telephone at 1-800-464-3641, option 1; or online at
www.optum36-coding.com
keyword New
				  York or
https://www.optum360coding.com/Product/40508/
.
(c) Authorized providers, including
				  psychologists and licensed clinical social workers, shall use the following
				  Common Procedural Technology (CPT) codes when telemedicine is used in
				  accordance with section 325- 1.8 of this Title, notwithstanding these codes not
				  appearing in the Official New York Workers' Compensation Behavioral Health Fee
				  Schedule. Use of these codes are limited to one unit per patient per day. Use
				  of these codes are not eligible for the enhanced reimbursement in Modifier 1B
				  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).
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.1 - Application to practice podiatry or for rerating

Current through Register Vol. 46, No. 28, July 10, 2024
Application by a duly licensed podiatrist of the State of
					 New York to practice or for rerating under the Workers' Compensation Law shall
					 be made upon a form furnished by the chair which shall be filed with the
					 Podiatry Practice Committee, Health Provider Administration, 100
					 Broadway-Menands, Albany, NY 12241. Such application shall state, fully and
					 truthfully, all the information required by law and the applicant shall make
					 and sign the statutory agreement. The chair will notify the podiatrist of
					 approval of his or her application within 60 days after receipt by the chair of
					 a recommendation for approval from the Podiatry Practice
					 Committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.2 - Investigation of application

Current through Register Vol. 46, No. 28, July 10, 2024
Upon the filing of such application the Podiatry Practice
					 Committee shall investigate and pass upon the same within 60 days of such
					 filing.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.3 - Notification to applicant of nonapproval

Current through Register Vol. 46, No. 28, July 10, 2024
Upon refusal to recommend approval of an application for
					 authority to practice or for rerating, the Podiatry Practice Committee shall
					 notify the applicant, in writing, of such refusal.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.4 - Investigation and hearing procedure

Current through Register Vol. 46, No. 28, July 10, 2024
In any investigation or hearing conducted before the
					 Podiatry Practice Committee pertaining to the revocation or suspension of the
					 authority of a podiatrist as provided under the Workers' Compensation Law, the
					 following rules of procedure shall apply:
(a) The accused podiatrist shall be given 30
				  days' notice in writing, containing a brief statement of the charge or charges
				  against such podiatrist and the time when and place where such charge or
				  charges will be heard. Such notice shall be served either personally or by
				  mail. At least 10 days prior to the return date in said notice, the accused
				  podiatrist shall file an answer with the Podiatry Practice Committee, answering
				  the charges contained therein.
(b)
				  On the hearing of such charge or charges, the accused podiatrist shall be
				  entitled to be represented by counsel and to cross-examine witnesses. Witnesses
				  shall be placed under oath. A verbatim record of the proceedings shall be
				  made.
(c) A true copy of the record
				  of each proceeding shall be submitted to the chairman, Workers' Compensation
				  Board, along with the report, findings and recommendation of the Podiatry
				  Practice Committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.5 - Conduct of hearing

Current through Register Vol. 46, No. 28, July 10, 2024
The Podiatry Practice Committee conducting a hearing shall
					 not be bound by common law or statutory rules of evidence or by technical or
					 formal rules of procedure, except as provided herein; but may make such
					 investigation or inquiry or conduct such hearing in such manner as it deems
					 advisable and necessary in the premises.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.6 - Decision of committee

Current through Register Vol. 46, No. 28, July 10, 2024
The Podiatry Practice Committee shall consist of three
					 members, two of whom shall constitute a quorum and may proceed with the
					 transaction of such business as may come before them, and a decision by a
					 majority of the committee shall be deemed the decision of the entire
					 committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 340 - Procedure Before Psychology Practice Committee › Section 340.7 - Committee chairman, secretary

Current through Register Vol. 46, No. 28, July 10, 2024
The chair shall designate a member of the Podiatry Practice
					 Committee as chairperson and shall also appoint a secretary of such
					 committee.
New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter E - Podiatry Practice › Part 341 - Podiatry Care And Treatment › Section 341.1 - Limitation of podiatry treatment

Current through Register Vol. 46, No. 28, July 10, 2024
A podiatrist who is authorized to treat workers'
					 compensation claimants shall be limited, pursuant to law, to the treatment of
					 injuries that affect only the foot and shall render such treatment only within
					 the field of his or her professional competence as recognized by his or her
					 authorized rating.