New York Codes, Rules and Regulations › Title 11 - INSURANCE › Appendices › Appendix 17-C

Current through Register Vol. 46, No. 28, July 10, 2024
(cf. §
								68.3)
Introduction.
Regional conversion factors are used in the Workers'
				Compensation medical fee schedule to recognize differences in the cost of
				conducting a medical practice in various geographic regions of the State.
				Regional conversion factors were developed after a study was made by the chair
				of the Workers' Compensation Board.
The components considered in the study made by the chair of the
				Workers' Compensation Board relative to the cost of conducting a medical
				practice generally apply to dentists, social workers, speech therapists and
				optometrists and, while there may be differences in some components, it has
				been determined by the superintendent that the percentage difference in
				relative cost by region applicable to physicians is also applicable to the cost
				of conducting a dental, social worker, speech therapy, optometric practice and
				by a thermographic technician. This determination will maintain consistency
				between the schedules established by the chair of the Workers' Compensation
				Board and specified schedules established by the superintendent under section
				5108 of the New York Insurance Law.
Regional conversion factors are listed in Parts A, C, D, I and
				L of this Appendix. For this purpose there are established four regions, based
				on the differences in the cost of maintaining various health provider practices
				in different localities of the State. The regions defined in Appendix 17-A of
				this Title, using United States Postal Service ZIP codes for the State of New
				York, are hereby adopted as being applicable to Parts A, C, D, I and L of this
				Appendix.
The fee payable for care and treatment rendered by health care
				providers in accordance with Parts A, C, D, I and L of this Appendix shall be
				determined by the region in which the services were rendered.
There are hereby established for each region the following
				regional conversion factors for the indicated Parts of this Appendix:
REGIONAL CONVERSION FACTORS
Region I
Region II
Region III
Region IV
A
(Dental)
$22.62
$23.70
$27.12
$29.47
C
(Social workers)
3.47
3.64
4.16
4.52
D
(Therapy)
6.22
6.51
7.45
8.10
I
(Eye exams)
15.89
16.65
19.05
20.70
L
(Thermography)
-Medical Doctor
44.55
46.67
53.41
58.04
-Dentist
44.55
46.67
53.41
58.04
-Chiropractic Doctor
42.33
44.35
50.75
55.14
To determine the maximum allowable fee for a procedure, it is
				necessary to multiply the unit value by the conversion factor.
Example: If the dental procedure designated as procedure 02510
				in the dental fee schedule is performed in Region II, the maximum allowable fee
				is determined by multiplying the unit value, 8.5, by 23.70, the dental
				conversion factor, i.e., 8.5 x 23.70 = 201.45.
POSTAL ZIP CODES INCLUDED IN EACH REGION
Region I
From
Thru
12007 .......
12099
12106 .......
12177
12184 .......
12199
12401 .......
12498
12701 .......
12792
12801 .......
12887
12901 .......
12998
13020 .......
13094
13101 .......
13167
13301 .......
13368
13401 .......
13439
13441 .......
13495
13601 .......
13698
13730 .......
13797
13801 .......
13865
14001 .......
14098
14101 .......
14174
14301 .......
14305
14410 .......
14489
14501 .......
14592
14701 .......
14788
14801 .......
14898
14901 .......
14905
Region II
From
Thru
12180 .......
12183
12201 .......
12257
12301 .......
12345
12501 .......
12594
12601 .......
12614
13201 .......
13260
13440 .......
-
13501 .......
13503
13901 .......
13905
14201 .......
14265
14601 .......
14692
Region III
From
Thru
10501 .......
10598
10601 .......
10650
10701 .......
10710
10801 .......
10805
10901 .......
10998
11901 .......
11980
Region IV
From
Thru
10001 .......
10099
10301 .......
10314
10401 .......
10475
11001 .......
11050
11101 .......
11111
11201 .......
11252
11301 .......
11390
11401 .......
11460
11501 .......
11598
11601 .......
11697
11701 .......
11798
11801 .......
11819
NUMERICAL LIST OF POSTAL ZIP CODES
From
Thru
Region
10001
10099
IV
10301
10314
IV
10401
10475
IV
10501
10598
III
10601
10650
III
10701
10710
III
10801
10805
III
10901
10998
III
11001
11050
IV
11101
11111
IV
11201
11252
IV
11301
11390
IV
11401
11460
IV
11501
11598
IV
11601
11697
IV
11701
11798
IV
11801
11819
IV
11901
11980
III
12007
12099
I
12106
12177
I
12180
12183
II
12184
12199
I
12201
12257
II
12301
12345
II
12401
12498
I
12501
12594
II
12601
12614
II
12701
12792
I
12801
12887
I
12901
12998
I
13020
13094
I
13101
13167
I
13201
13260
II
13301
13368
I
13401
13439
I
13440
-
II
13441
13495
I
13501
13503
II
13601
13698
I
13730
13797
I
13801
13865
I
13901
13905
II
14001
14098
I
14101
14174
I
14201
14265
II
14301
14305
I
14410
14489
I
14501
14592
I
14601
14692
II
14701
14788
I
14801
14898
I
14901
14905
I
Part A. Dental fee schedule.
[Reserved]
Part B. Private nursing services fee schedules.
(a) Registered professional nurses. The
			 maximum permissible charge for private nursing services is the local prevailing
			 charge for such services.
(b)
			 Licensed practical nurses. The maximum permissible charge for private nursing
			 services Is the local prevailing charge for such services.
Part C. Psychiatric social worker fee schedule.
The maximum permissible charge for any duly licensed
				psychiatric social worker's services is the product of the unit value shown in
				the following schedule and the regional conversion factor set forth in this
				Part. For psychiatric services performed by a physician, see the Workers'
				Compensation medical fee schedule.
Psychiatric social worker
						  services
Unit value
Office visit, 50 minutes (prorated)
16.0
Home visit, 50 minutes (prorated)
17.5
Group therapy, per recipient (maximum 8 persons per
						  group)
45-50 minutes, office
4.0
90 minutes, office
6.4
PART C
REGIONAL CONVERSION FACTORS
(Effective September 1, 1994)
Region
1
Regional conversion
						  factor
I
$3.47
II
3.84
III
4.16
IV
4.52
Psychological fee schedule. Please refer to the Workers'
				Compensation psychology fee schedules.
Part D. Speech therapy fee schedule.
The maximum permissible charge for any service performed by a
				qualified speech therapist is the product of the unit value shown in the
				following schedule and the regional conversion factor set forth in this Part.
				For physical and occupational therapy, see the Workers' Compensation medical
				fee schedule.
Therapy
						  services
Unit value
1.
Therapy sessions at a clinic, hospital
						  outpatient department or therapist's office:
Individual therapy session:
30 minutes or less
4.70
more than 30 minutes
6.40
Group therapy session, per patient:
Group of two:
90 minutes or less
6.42
more than 90 minutes
8.74
Group of three:
90 minutes or less
4.70
more than 90 minutes
6.40
Group of four:
90 minutes or less
3.75
more than 90 minutes
5.11
2.
Comprehensive evaluation and written report
						  by a speech pathologist
9.8
PART D
REGIONAL CONVERSION FACTORS
(Effective September 1, 1994)
Region
1
Regional conversion
						  factor
I
$6.22
II
6.51
III
7.45
IV
8.10
Part E. [Reserved]
Part F. [Reserved]
Part G. Ambulance and other common carrier transportation.
(a) The maximum permissible charge
			 for ambulance service is the local prevailing charge for such
			 service.
(b) The maximum
			 permissible charge for other common carrier transportation is the local
			 prevailing charge for such service, based on the most direct route.
Part H. Hearing aid supplies and services.
The maximum permissible charge for hearing aid supplies and
				services is the actual cost of the hearing aid to the provider, plus:
(a) in the case of a monaural instrument, a
			 dispensing fee of $266;
(b) in the
			 case of a binaural instrument, a dispensing fee of $344.
Part I. Eye examinations and related services fee
				schedule.
The maximum permissible charge for eye examinations or related
				services performed by an optometrist is the product of the unit value shown in
				the following schedule and the regional conversion factor set forth
				below:
Optometric services
Unit value
Eye examination, with refraction and prescription for
						  glasses, if required
2.32
Clinical services:
One-hour session:
3.63
Two-hour session:
5.77
(For eye examinations and other professional services performed
				by an ophthalmologist, see the section labeled Ophthalmological Diagnostic and
				Treatment Services, starting with Code 92002 in the Workers' Compensation
				medical fee schedule.)
PART I
REGIONAL CONVERSION FACTORS
(Effective September 1, 1994)
Region
1
Regional conversion
						  factor
I
$15.89
II
16.65
III
19.05
IV
20.70
Part J. Eyeglasses fee schedule.
(a) The maximum permissible charge for
			 providing and fitting eyeglasses shall be equal to the sum of:
(1) the actual cost of the frames to the
			 provider, not to exceed $27[DAGGER], plus a dispensing fee of $28;
			 and
(2) a charge for obtaining and
			 dispensing lenses, not to exceed $51 for single vision lenses, $82 for bifocal
			 lenses, and $97 for trifocal lenses.