New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter V - Workers' Compensation
Subchapter M - Pharmacy And Durable Medical Goods Fee Schedules And Appendices
Part 444 - Dental Fee Schedule
Section 444.2 - Fee schedule
Current through Register Vol. 46, No. 12, March 20, 2024
(a) The dental fee schedule for all dental services shall be the Official New York Workers' Compensation Dental Fee Schedule, First Edition, March 1, 2009, prepared by the chair and published by the board, which is hereby incorporated by reference, except that the maximum reimbursement for dental services in cases in which the insurance carrier files or has filed a notice of controversy pursuant to Workers' Compensation Law, section 25(2)(a) or (b) shall be 25 percent more than the fees set forth in the Official New York Workers' Compensation Dental Fee Schedule.
(b) The Official New York Workers' Compensation Dental Fee Schedule incorporated by reference herein may be examined at the office of the Department of State, 99 Washington Avenue, Suite 650, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the board in Albany, Binghamton, Brooklyn, Buffalo, Hauppauge, Hempstead, Manhattan, Peekskill, Queens, Rochester and Syracuse. Copies may be obtained from the board by writing to New York Workers' Compensation Dental Fee Schedule, Bureau of Health Management, New York State Workers' Compensation Board, 100 Broadway-Menands, Albany, NY 12241 or by telephone at 1-800-781-2362 or by email at general_information@wcb.state.ny.us
(c) The dental fee schedule shall be updated by the chair as he or she deems warranted by changes in market rates. The dental fee schedule consists of a list of current dental terminology (CDT) codes and descriptions of treatment services and procedures as published by the American Dental Association with a corresponding maximum fee to be charged by dental providers. Nothing shall prohibit a provider from charging a fee that is less than the fee schedule.
(d) Any treatment or procedure provided in connection with a work related injury not specifically contained in the dental fee schedule should be billed using CDT Code D9999 "Unspecified Adjunctive Procedure By Report" (BR). The provider should establish a fee consistent in relativity with the other fees listed in the dental fee schedule. Any bill submitted by a dental provider which lists CDT Code D9999 shall be accompanied by a report providing the reasons why such procedure is necessary to treat the injured employee.
