Board Bulletins and Subject Numbers

May 13, 2025

As part of Governor Kathy Hochul's Fiscal Year 2026 Budget signed into law on May 9, 2025, effective immediately, physicians who are training in residency and fellowship programs accredited by the Accreditation Council on Graduate Medical Education (ACGME) are permitted to treat injured workers in New York State under the appropriate supervision of faculty physicians (see Workers' Compensation Law Section 13-b[2][b-2]).

This means that upwards of 20,000 resident and fellow physicians, training in over 1,400 programs, at nearly 70 teaching hospitals across New York State, may now treat injured workers. This is great news for New Yorkers, as increasing provider participation at New York's world-renowned academic hospitals and health care systems will go a long way in helping injured workers access the quality medical care and treatment they need, across the state and across all medical specialties.

If you are a resident or fellow physician, you can access important guidelines and resources about treating injured workers in New York, including training eligible for Continuing Medical Education credit, at wcb.ny.gov/residents-fellows.

This Subject Number will provide guidance with respect to this new legislation to assist resident and fellow physicians, physicians who supervise residents and fellows as well as their staff, and carriers and self-insured employers.

Treatment

A resident or fellow physician enrolled in a graduate medical education training program that is accredited by the ACGME, the national oversight body for physician residency/fellowship training, is permitted to render treatment to injured workers under the supervision of a physician who is authorized by the New York State Workers' Compensation Board (Board). That supervision must be consistent with the New York Education Law and any other relevant state and federal standards. Residents and fellows do not need to be authorized by the Board to treat injured workers - they may treat under the supervision of an authorized physician.

Reports

Similar to the information required by other medical insurance programs, clinical notes of the treatment of an injured worker must clearly identify the name of the resident or fellow providing the care, the name of the physician supervising the resident or fellow, and the training program or institution.

All clinical notes of the treatment of an injured worker must clearly state:

1. whether the condition was caused by work;
2. whether the patient is working; and
3. the patient's percentage of temporary disability.

PARs

If a prior authorization request (PAR) is necessary to proceed with treatment, the PAR must be filed by the supervising physician or their designated delegate in the Board's online business information system, OnBoard. Residents and fellows will not be permitted to independently submit, track, or escalate PARs.

Billing

Treatment rendered by residents and fellows can only be billed by the Board-authorized physician supervising the resident or fellow, by submitting a CMS-1500 form.

When billing for non-surgical services provided by residents or fellows, supervising physicians must bill using the Official New York Workers' Compensation Medical Fee Schedule and use the modifier 1R. Services billed using the modifier 1R must be billed and paid at the same amount payable for such services had they been performed directly by the supervising, authorized, billing physician.

When billing for services where the resident or fellow is functioning as an assistant at surgery, supervising physicians must bill using the Official New York Workers' Compensation Medical Fee Schedule and use the modifier 81. Codes billed with modifier 81 must accurately represent work performed by the resident or fellow and be documented appropriately in the surgical report. Surgical services billed using modifier 81 must be billed and paid at the percentage in effect (currently 16%) for the physician code fee or fees, and only for the procedure or procedures in which the resident or fellow assisted.

A Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0) may only be submitted by the Board-authorized supervising physician who submitted the bill, and not by a resident or fellow physician.

In the near future, the Board will propose regulations implementing the legislation. Check the Board's Regulations page for updates.

The Board is excited to welcome residents and fellows into the workers' compensation system. If you have any questions, please contact the Medical Director's Office at MDO@wcb.ny.gov.