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Tip 18

Telemedicine—for Evaluation and Management Services—is Covered by No-Fault for Duration of the COVID-19 Threat

Posted By Erin S. Stamper || 3-April-2020

On March 16, 2020, the Workers’ Compensation Board (WCB) promulgated amendments to the Workers’ Compensation Fee Schedule, permitting doctors, acupuncturists, physical therapists, occupational therapists, chiropractors, psychologists, and licensed clinical social workers to engage in “telemedicine” during the COVID-19 crisis.[i]

The WCB promulgated these amendments “as an emergency measure because the Board wants to avoid health and safety risks that can be avoided through social distancing due to the outbreak of COVID-19, by allowing telemedicine in some circumstances.”[ii]

Under these amendments, doctors, psychologists, and licensed clinical social workers are now permitted to bill for telephone evaluation and management services provided to established patients in the following increments:

  • 99441 (5-10 minutes of medical discussion)
  • 99442 (11-20 minutes of medical discussion)
  • 99443 (21-30 minutes of medical discussion)

Acupunctures, physical therapists, occupational therapists, and chiropractors however, are permitted to bill for telephone evaluation and management services provided to established patients in one increment only:

  • 99441 (5-10 minutes of medical discussion)

On March 23, 2020, the Department of Financial Services (DFS) confirmed that the emergency amendments promulgated by the WCB also apply to No-Fault and will continue to apply in No-Fault for as long as the Workers’ Compensation Board’s emergency regulations are in effect.[iii] Therefore, during the COVID-19 crisis, No-Fault providers may bill for telephone evaluation and management services provided to established patients pursuant to the rates set forth in the Workers’ Compensation Fee Schedule.[iv]

It should be noted that the use of these codes is strictly limited to one unit per patient per day. In other words, the authorized provider may only bill for one telephone evaluation and management service per day. Furthermore, when billing, the authorized provider must indicate on its report that such assessment was done using telemedicine as a result of social distancing due to the outbreak of COVID-19. Lastly, the treating provider should keep a detailed record, denoting the start and end time of each telephone evaluation to support the CPT Code billed, in order to prevent the No-Fault insurer from Downcoding the bill later.

Conclusion

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 are impacted by these emergency regulations.

In the interim, should a denial be received, for treatment rendered pursuant to the new COVID-19 Telemedicine guidelines, said denial should be transferred to Russell Friedman & Associates for immediate review.

The Firm will continue to monitor for all Regulatory developments stemming from the COVID-19 crisis and post additional updates as they become available.


[i] Emergency Adoption of Amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 (COVID-19 Telemedicine), http://www.wcb.ny.gov/content/main/wclaws/Covid-19/

[iii] See, Coronavirus (COVID-19) information: Auto Insurance FAQs, https://www.dfs.ny.gov/consumers/coronavirus/auto_insurance_faqs.

[iv] Notably absent from the emergency amendment promulgated by the WCB is a provision addressing tele-radiology, which has long been the norm with private insurers

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  • Creative & Innovative Solutions

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What Sets Us Apart From Our Competitors?

  • Fighting for Compensation

    We use negotiation, arbitration, or litigation to ensure medical providers are fairly compensated for their services.

  • Experienced Attorneys

    We have a team of trusted and respected attorneys to ensure your case is matched with the best attorney possible.

  • Client-Focused Approach

    We’re a client-centered, results-oriented firm. When you work with us, you can have confidence we’ll put your best interests at the forefront of your case – it’s that simple.

  • We'll Fly to You

    We fly throughout New England to meet with medical providers and hospitals to help them with collection, consulting and compliance.

  • Creative & Innovative Solutions

    No two cases are the same, and their solutions shouldn’t be either. Our attorneys provide creative points of view to yield exemplary results.

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