The New York State Workers' Compensation Board Proposes Acupuncture Fee Schedule Impacting No-Fault Providers

Posted By Erin S. Stamper || 8-Oct-2019

On July 3, 2019, the New York State Workers’ Compensation Board (WCB) proposed new fee schedule sections for Acupuncture, Physical, and Occupational Therapy. If adopted, these changes would affect services rendered to New York State Workers’ Compensation and No-Fault patients on or after January 1, 2020. Acupuncture services would be particularly affected as follows:

  1. Licensed acupuncturist would only be permitted to use the following 6 CPT codes contained in the Acupuncture Fee Schedule:

CPT 99201 Initial E/M

CPT 99211 Re-Evaluation

CPT 97810 Acupuncture

CPT 97811 Acupuncture

CPT 97813 Acupuncture

CPT 97814 Acupuncture

*Note—A licensed acupuncturist would not be permitted to use codes that do not appear in the new Acupuncture Fee Schedule. Similarly, Chiropractors, who are licensed acupuncturists, would only be permitted to use the Chiropractic Fee Schedule when performing acupuncture services. And, physicians, who are licensed acupuncturists, would only be permitted to use the Medical Fee Schedule, when performing acupuncture services.

  1. No additional reimbursement would be provided when acupuncture is combined with moxibustion or other similar adjunctive procedures, like cupping.
  1. The maximum reimbursement limitations per patient, per day, per accident or illness for modalities would be 12.0 Relative Value Units (RVUs), re-evaluation plus modalities would be 15.0 RVUs, and initial evaluation plus modalities would be 18.0 RVUs.
  1. When a patient receives acupuncture, chiropractic, physical or occupation procedures or modalities from more than one provider, the patient would not be permitted to receive more than 12 RVUs per day per accident or illness from all providers. The following codes represent the acupuncture procedures subject to this rule:
  1. The Evaluation and Management Ground Rules recommend that the provider should re-evaluate the efficacy of the treatment or modality 2-3 weeks after the initial visit and every 3-4 weeks thereafter.

It is the Firm’s understanding that the New York State Department of Financial Services (“DFS”) will not be passing an emergency regulation delaying the application of this new fee schedule rate to No-Fault (i.e. to treatment rendered to automobile accident victims). As such, these updated and newly established rates will affect all treatment rendered to No-Fault patients on or after January 1, 2020.

The Firm encourages its clients to speak directly with their billing and coding professionals to obtain a more in depth understanding of the services that will be impacted by these proposed amendments.

The full text of the proposed amendment can be found on the WCB’s website via the following link: http://www.wcb.ny.gov/content/main/wclaws/medical-fee-schedules-update-2019/.

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