Circular Letter No. 9 (1996)

June 21, 1996


All Automobile Self-Insurers, and Insurers Licensed to Write Automobile Insurance in New York State and All Workers' Compensation Insurers Licensed to Write Workers' Compensation Insurance in New York State


Revision of the NYS Workers' Compensation Board Schedule of Medical Fees

The Workers' Compensation Board is in the process of revising its fee schedules to utilize the American Medical Association's Current Procedural Terminology (CPT) coding. It is anticipated that the revision to the schedules will be completed by September 1, 1996 and become effective on October 1, 1996. When the new schedules are introduced by the Workers' Compensation Board all billings must conform to the new format. The Chiropractic, Psychology and Podiatry fee schedules will remain available as independent schedules that can be acquired separately.

CPT coding utilizes a 5 digit number to identify the medical procedure being performed and billed, and provides a description of the procedure and what the performance of that procedure entails. This modification to the fee schedules should reduce provider billing confusion and simplify the billing process by adopting a nationally accepted billing standard. The new fee schedule conversion is expected to be revenue neutral and should not add any costs to the No-Fault or Workers' Compensation systems.

All No-Fault and Workers' Compensation insurers are encouraged to acquire the new schedules and begin training staff in the proper application of the fee schedules. Insurers that believe they require fundamental training in the proper operation of the fee schedules should contact Senior Examiner Hoda Nairooz at (212) 602-0334, and she will attempt to have a representative placed in a training seminar to be given by the Medical Society of the State of New York in conjunction with the Workers' Compensation Board.

Please inform Ms. Nairooz of the type of training required and preferred locations so that the training seminars can be appropriately structured and conducted at convenient sites. Due to limited space availability, only supervisory personnel and medical payment reviewers should participate in this training. It is suggested that only one insurer representative per company be trained.

Additionally, the Workers' Compensation Board will no longer be distributing the new fee schedules. The fee schedules will be available for purchase exclusively through Medicode Inc. and will be tentatively available on September 1, 1996. The schedules will be available in both hard copy and on computer diskette. To acquire a copy of the fee schedules, please contact Medicode Publications, Workers' Compensation Customer Services at 1-800-765-6023.

Any questions regarding this circular letter should be directed to Ms. Hoda Nairooz at (212) 602-0334.

Please acknowledge receipt of this circular letter to:

Ms. Hoda Nairooz, Senior Examiner
Property/Casualty Bureau
New York State Insurance Department
160 West Broadway
New York, NY 10013-3383