While the 8.0 Relative Value Units (“RVU”) limit set forth
in in Ground Rule 11 of the Physical Medicine Section of the Workers Compensation
Board (“WCB”) Fee Schedule appears to allow multiple providers,
with disparate skill sets, who are treating different conditions on the
same date, to obtain reimbursement for the No-Fault benefits provided,
the Firm anticipates that no-fault arbitrators, without more formal guidance
regarding WCB’s intent, will continue to issue disparate decisions
regarding the 8-Unit Rule.
The Firm’s opinion in this matter is based on a communication recently
received from a Vice President of the American Arbitration Association
(“AAA”), the not-for-profit organization which administers
the arbitration of disputed No-Fault claims on behalf of the New York
State Department of Financial Services. On April 23, 2018, the Firm received
the following e-mail from Vice President James Skelton:
From: James Skelton <SkeltonJ@adr.org>
Sent: Monday, April 23, 2018 11:00 AM
To: Bruce Klein <firstname.lastname@example.org>; Erin Stamper <email@example.com>
Subject: Fee Schedule - PT Rules
Dear Bruce and Erin - The Workers’ Compensation Board has recently
advised the Department that the following email regarding PT rules is
not the Board’s official position. If you have any questions, please
contact Chris Maloney at
firstname.lastname@example.org or (212) 480-5586.
Supervising Insurance Examiner
Property Bureau – Claims Administration Unit
New York State Department of Financial Services
One State Street Plaza, 6th floor, New York, NY 10004+1511
Ph: (212) 480-5586 | Fax: (212) 709-1570 |
From: MacMaster, Heather (WCB)
Sent: Tuesday, January 30, 2018 3:59 PM
To: Maloney, Chris (DFS) <Chris.Maloney@dfs.ny.gov>
Cc: Woods, MaryBeth (WCB) <MaryBeth.Woods@wcb.ny.gov>; Smith, Steven (WCB) <Steven.Smith@wcb.ny.gov>
Subject: Fee Schedule: PT rules
Here is the PT information from our MDO.
The 8 RVU limitation is per patient per day regardless of how many body
parts are treated or how many practitioners treat. The only exception
is with chiro and PT. If a chiro renders manipulation only (98940-98943)
and does not bill any of the other physical medicine codes, the injured
worker could receive chiro and PT on the same day. This scenario is usually
performed by a chiro who is affiliated with the Chiropractic Council.
They only perform manipulation.
The physical medicine codes that are impacted by the 8 RVU limitation are
in the chiro physical medicine fee schedule but the codes for spinal manipulation
are not in the general physical medicine fee schedule.
Deputy General Counsel
NYS Workers’ Compensation Board
328 State Street, Schenectady, NY 12305
(518) 486-9564 |
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