The 8 Unit Rule:
Erin S. Stamper
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
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
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