New Workers' Compensation DME Rules and Fee Schedule

by: NYSCA Insurance Committee
Category: Insurance News
Tags
Oct
25

NYSCA has previously communicated that the revised January 1, 2020 New York Workers' Compensation Fee Schedule included reference to an updated Durable Medical Equipment (DME) Fee Schedule.

Just last month the Workers' Compensation Board (WCB) released another statement noting that such DME schedule would be forthcoming.

Please note the following links detailing both updated authorization requirements and DME Fee schedule as published and released by the WCB:

Update to the rules and regulations:

As filed in the New York State Register dated October 21, 2020:

https://www.dos.ny.gov/info/register/2020/102120.pdf
Requesting Prior Approval (pages 17-20) and DME Fee Schedule Pages 19-21

From the WCB web portal:

http://www.wcb.ny.gov/content/main/wclaws/442_2_DME_FEE_Schedule/text.pdf

The Office New York Workers' Compensation Durable Medical Equipment Fee Schedule can be obtained directly from the Workers' Compensation Web Portal at:

http://www.wcb.ny.gov/content/main/hcpp/DME-Fee-Schedule.pdf

Note that the effective date for the updated DME Fee Schedule is January 1, 2021. Also note the Introduction:

‘The Official New York Workers’ Compensation Durable Medical Equipment (DME) Fee Schedule lists the DME that may be supplied to an injured worker when medically necessary and in accordance with the applicable medical treatment guidelines. The items on the DME Fee Schedule are described by using applicable Healthcare Common Procedure Coding System (HCPCS) codes and terminology. The purchase price for each item is included in the PURCHASE column, and the weekly rental price is listed in RENTAL PER WEEK column.
IMPORTANT: Items listed in the PAR REQUIRED column require prior authorization before they may be supplied to an injured worker. When prior authorization is required, the health care provider should submit that request using the Board’s established prior authorization process.’

The NYSCA will provide updated information and Webinars to keep you updated on this and other important changes that may impact you.

Thank you to all who attended our Virtual Convention last weekend. We hope you found the information provided interesting, and most importantly, applicable to your patients and your practice.

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