New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 4 - Fees and Reimbursement
Part 533 - State Reimbursement For Payment To Physicians
Section 533.2 - Definitions
Current through Register Vol. 46, No. 39, September 25, 2024
When used in this Part, unless otherwise expressly stated or unless the context or subject matter requires a different interpretation, the terms hereinafter set forth shall be interpreted in accordance with the definitions herein provided.
(a) Reimbursement shall mean State reimbursement.
(b) Maximum reimbursable allowance shall mean that portion of the expenditures for any service or procedure which is subject to reimbursement.
(c) By report shall mean the maximum reimbursable allowance determined on an individual basis, in consideration of the nature, extent, and need for the procedure or service, the time, skill and equipment necessary therefor, and such other factors as may be pertinent.
(d) Clinic fees shall mean fees for services provided in organized clinics of hospitals possessing valid operating certificates issued by the New York State Department of Health and for services of physicians in providing prior arranged group care, outside a hospital clinic setting in the physically handicapped children's program and in the New York State vocational rehabilitation program.
(e) Consultation shall mean the advice and counsel, from an accredited specialist called in by the responsible physician, necessary to further treatment of the case by the responsible physician.
(f) Conversion factor shall mean the dollar amount by which the value of a procedure or service is multiplied to determine the maximum reimbursable allowance.
(g) Value shall mean the relative factor assigned to a procedure or service by which the conversion factor is multiplied to determine the maximum reimbursable allowance.
(h) Home call shall mean services rendered to a patient in a private household or in a boarding home, nursing home, convalescent home, proprietary home for adults, private home for the aged, institution for the blind, or child caring institution.
(i) New illness shall mean an illness or condition for which the patient has not received continuous or intermittent care from the physician providing the service.
(j) Referral shall mean the transfer of a patient from one physician to another for definitive treatment.
(k) The notation T shall mean one time unit for each 15 minutes of anesthesia time.
(l) Services or procedures shall mean the services or procedures provided by a physician or an osteopathic physician.
(m) Intensive care shall mean extraordinary care by the responsible physician in personal attendance in the care of a medical emergency, both directing and personally administering specific corrective measures after initial examination has determined the nature of the ailment.
