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

Current through Register Vol. 46, No. 12, March 20, 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

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

Region II

Region III

Region IV

NUMERICAL LIST OF POSTAL ZIP CODES

Part A. Dental fee schedule.

[Reserved]

Part B. Private nursing services fee schedules.

PART C

REGIONAL CONVERSION FACTORS

(Effective September 1, 1994)

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.

PART D

REGIONAL CONVERSION FACTORS

(Effective September 1, 1994)

Part E. [Reserved]

Part F. [Reserved]

Part G. Ambulance and other common carrier transportation.

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:

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:

(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)

Part J. Eyeglasses fee schedule.

This limitation shall not apply when the frames are identical to or substantially the same design and cost as frames damaged, lost, or otherwise requiring replacement as a result of an automobile accident; in such case, the maximum permissible charge is the actual cost of the frames to the provider, plus a $28 dispensing fee.

Part K. Fee schedule for services rendered in accordance with a religious method of healing. The maximum permissible charge for nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of the State of New York, by a practitioner accredited to provide such care and treatment is $27 per day.

[FN1] Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal ZIP codes contained in the introduction to Appendix 17-C.

[FN1] Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal ZIP codes contained in the introduction to Appendix 17-C.