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Medical Fee Schedules When Medical Treatment Takes Place in Another State

Medical Fee Schedules

Frequently Asked Questions

  • If I am a NYS licensed provider, can I treat NYS workers' compensation claimants in other states?

    NYS licensed providers can only treat NYS workers' compensation claimants if they are authorized by the Board. Under 12 NYCRR 323.1(i), unless otherwise permitted by law, a provider permitted to seek authorization by the Board must obtain such authorization prior to treating injured workers under the Workers' Compensation Law. This is true even if the provider has a license in the state where the claimant is treating.

  • If treatment is rendered out of state for a claimant who resides out of state, how is the bill reimbursed if the provider is licensed and authorized in NYS?

    A provider who is licensed in NYS and WCB authorized will be reimbursed at the NYS WCB Medical Fee Schedule rate regardless of where treatment is rendered if it is a NYS workers' compensation claim in accordance with 12 NYCRR 329-1.3, 12 NYCRR Part 329-4, 12 NYCRR Part 333, and 12 NYCRR 348.2.

  • If treatment is rendered out of state for a claimant who resides out of state, how is the bill reimbursed if the provider is not licensed in NYS?

    A provider who is not licensed in NYS will be reimbursed at the fee schedule rate in the state where treatment was rendered. If there is no fee schedule for that state, payment will be at the prevailing rate in the community for similar treatment.

  • If treatment is rendered out of state, but the claimant resides in NYS, how is the bill reimbursed?

    Claimants who reside in NYS may treat with a Board authorized out-of-state medical provider or a provider who is licensed and qualified in the state where treatment is rendered when such treatment conforms to the Workers' Compensation Law and regulations, the MTGs, and the Medical Fee Schedule. The regional conversion factor for the ZIP code where the claimant resides will be used in payment of the bill. A provider who is licensed in NYS and thus capable of being Board authorized may not treat without Board authorization even if the provider is licensed in the state where the treatment is rendered, in accordance with 12 NYCRR 329-1.3, 12 NYCRR Part 329-4, 12 NYCRR Part 333, and 12 NYCRR 348.2.