New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter B - Property and Casualty Insurance
Part 68 - Charges For Professional Health Services
Section 68.1 - Adoption of certain workers' compensation schedules
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 68.1
Current through Register Vol. 46, No. 12, March 20, 2024
(a)
(1) The existing fee schedules prepared and
established by the chair of the Workers' Compensation Board for industrial
accidents are hereby adopted by the Superintendent of Financial Services with
appropriate modification so as to adapt such schedules for use pursuant to the
provisions of Insurance Law section
5108.
(2)
(i)
Notwithstanding paragraph (1) of this subdivision, and except as provided in
subparagraph (ii) of this paragraph, the amendments to the fee schedules set
forth in Parts 329, 333, 343, and 348 of Title 12 NYCRR that were promulgated
by the chair of the Workers' Compensation Board on December 11, 2018, and the
amendments to the fee schedules set forth in Parts 329, 333, and 348 of Title
12 NYCRR that were adopted by the chair of the Workers' Compensation Board on
November 19, 2019, shall take effect for purposes of Insurance Law section
5108 on October 1, 2020, and shall only
apply to all charges for health services performed on or after October 1,
2020.
(ii) The following ground
rules in the amendments to the fee schedules set forth in Parts 329, 333, 343,
and 348 of 12 NYCRR that were promulgated by the chair of the Workers'
Compensation Board on December 11, 2018, shall take effect for purposes of
Insurance Law section
5108 on April 1, 2019, and shall apply to
all charges for health services performed on or after April 1, 2019:
(a) General Ground Rule 10 in the Workers'
Compensation Chiropractic Fee Schedule set forth in 12 NYCRR 348;
(b) General Ground Rule 19 in the Workers'
Compensation Medical Fee Schedule set forth in 12 NYCRR 329;
(c) General Ground Rule 13 in the Workers'
Compensation Behavioral Health Fee Schedule (formerly the Psychology Fee
Schedule) set forth in 12 NYCRR 333, and;
(d) General Ground Rule 16 in the Workers'
Compensation Podiatry Fee Schedule set forth in 12 NYCRR
343.
(b)
(1) The
charges for services specified in Insurance Law section
5102(a)(1) and any further
health service charges that are incurred as a result of the injury and that are
in excess of basic economic loss, shall not exceed the charges permissible
under the schedules prepared and established by the chair of the Workers'
Compensation Board for industrial accidents that are in effect for purposes of
no-fault at the time the charges are incurred. However, references to workers'
compensation reporting and procedural requirements in such schedules do not
apply to no-fault, e.g., requirements that provide for authorization to perform
surgical procedures. The general instructions and ground rules in the workers'
compensation fee schedules apply, but those rules that refer to workers'
compensation claim forms, pre-authorization approval, time limitations within
which health services must be performed, enhanced reimbursement for providers
of certain designated services, and dispute resolution guidelines do not apply,
unless specified in this Part.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
