Board-authorized providers
Board authorized providers, including Acupuncturists, Chiropractors, Licensed Clinical Social Workers, Nurse Practitioners, Occupational Therapists, Physical Therapists, Physicians, Physician Assistants, Podiatrists, Psychologists can bill for services in treating New York's injured workers.
Specialties who must bill through a supervising provider
Certain specialties who can treat must bill through their supervising provider as follows:
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Physical Therapy Assistants
When billing for PTA services, supervising authorized physical therapists must select codes from The Official NYS Workers' Compensation Physical and Occupational Therapy Fee Schedules that are permissible and within the scope of practice for PTAs using modifier CQ. Services billed using this modifier should be priced/billed and paid at 85 percent of the amount payable for such services had them been performed directly by the Board-authorized physical therapist.
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Occupational Therapy Assistants
When billing for OTA services, supervising authorized OTs must select codes from The Official NYS Workers' Compensation Physical and Occupational Therapy Fee Schedules that are permissible and within the scope of practice of OTAs using modifier CO. Services billed using this modifier should be priced/billed and paid at 85 percent of the amount payable for such services had them been performed directly by the Board-authorized occupational therapist.
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Resident/Fellow Physicians
Services provided by residents and fellows are billed by the supervising physician at the regular Official New York Workers' Compensation Medical Fee Schedule, using the modifier 1R. This modifier does not reduce the amount of the fee billed; it identifies that the services were provided by a resident/fellow physician, under the supervision of the authorized billing physician. In instances where the resident/fellow physician assists during surgery, the fee is billed by the surgeon using modifier 84 and paid at 16% of the applicable physician code fee.
Other treating providers
Other specialties who treat injured workers may also bill for services. These include: Audiologists, Dentists, and Optometrists, DME Suppliers and Pharmacies.
Emergency providers and out-of-state providers
Providers who treat injured workers in an emergency, as well as out-of-state providers can also submit bills for treating injured workers.
Important billing requirements
All providers who bill for services in treating injured workers must use the CMS-1500 universal billing form with an accompanying medical narrative. The bill and medical report must be submitted electronically through a Board-approved electronic submission partner, otherwise the provider will not be paid. Visit the CMS-1500 Initiative webpage for information and resources related to the CMS-1500 universal billing form and electronic submission mandate.
Contact us
If you have any questions about the billing for workers' compensation-related services, please contact the Medical Director's Office at MDO@wcb.ny.gov or by calling (800) 781-2362.