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

Current through Register Vol. 46, No. 12, March 20, 2024

(cf. Part 68)

SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL SERVICES

Effective 1/1/85 - 12/31/85

Room other than an operating room when used for minor surgery or emergency treatment:

For the medical service provided, whether by employed staff, attending staff or by contractual arrangement with the physician groups, the fee for this service is the fee as appears on line 90010 of the Schedule of Medical Fees.

For the hospital providing intern or resident staffing or by physician group contractual coverage, the total fee is the fee for physician services as appears on line 90010 of the Schedule of Medical Fees plus the fee for use of the Emergency Service Room as set forth below.

When the care is provided by an attending physician, the hospital fee is the Emergency Service Room fee as set forth below, with the physician billing separately.

Note: The above fees include common or ordinary medications.

Crutches, mechanical splints and appliances Rental or sale at cost Plaster cast and/or splint Cost of plaster Radium and deep therapy A & A (authorization and arrangement) E.K.G., E.E.G., X-RAY, P.T. and laboratory charges Rates in Schedule of Medical Fees promulgated by the Chairman, Workers' Compensation Board.....................

Material supplied by the emergency room (i.e., sterile trays, medications, etc.) over and above those usually included with the emergency room visit may be charged for separately. Itemize these on the bill submitted.

COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES

A study was undertaken to determine the low-cost drugs which a large umber of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive emergency room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list, or heretofore regarded as common or ordinary, or any additional drugs so regarded, should be considered as covered by the applicable emergency room rate.

No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients.

Current List of "No Charge" Drugs and Pharmaceutical Supplies

Acetaminophen 325 mg tablet

Alcohol 70 percent

Alcohol swabs

Antacid (e.g., Mylanta, Maalox, etc.)

Aspirin 325 mg tablet

Aromatic spirits of ammonia

Atropine 2 percent ophthalmic solution

Atropine 0.4 mg/ml

Bacitracin ointment

Castor oil

Calamine lotion

Collodion flexible

Cold cream

Clinitest tablets

Dibucaine 1 percent ointment (e.g., Nupercainal)

Epinephrine injection

Ethyl Chloride spray

Gelfoam

Glycerin suppository

Hematest tablets

Hydrocortisone 1 percent ointment

Hydrogen Peroxide

Iodine

Ipecac syrup

Lidocaine 2 percent viscous (e.g., Xylocaine)

Lidocaine 1 percent with/without Epinephrine

Lidocaine 2 percent with/without Epinephrine

Lidocaine 5 percent ointment

Lindane lotion (e.g., Kwell)

Lubricating jelly

Magnesium Sulfate

Meperidine injection (e.g., Demerol)

Merthiolate

Neomycin and Polymyxin B Sulfates w/ Hydrocortisone ophthalmic suspension ( e.g. Cortisporin)

Nitroglycerin 0.4 mg s.1. tablet

Nitroglycerin 0.6 mg s.1. tablet

Peppermint Spirit

Petrolatum

Providone-Iodine solution (e.g., Betadine)

Pralidoxime Chloride (e.g., Protopam)

Silver Nitrate sticks

Silver Sulfadiazine cream (e.g., Silvadene)

Sodium Chloride - injection

Sodium Chloride for irrigation

Sterile water for irrigation

Talcum powder

Tetanus Toxoid

Tuberculin PPD (1st and 2nd strength)

Witch Hazel

Zinc Oxide ointment