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Auto Casualty

New York No-Fault Fee Schedule: What You Need to Know

September 14, 2020
3 MIN READ

Miriam Encarnacion

In October, New York will implement major changes to its fee schedule for auto casualty no-fault claims, which includes increased rates and significant changes to specific ground rules stating that providers may not bill outside of their section of the fee schedule. Find out what you need to know now to comply and what impact it may have for insurers and medical providers operating in the state of New York.

What’s New in the New York No-Fault Fee Schedule

More than 25 changes will go into effect under the new fee schedule for health services performed on or after October 1, 2020, modifying the previous fee schedule, which was last updated in 2012. More information about the updates can be found in the 34th amendment and 35th amendment to 11 NYCRR 68 (Insurance Regulation 83). To summarize, some of the updates include:

1. Physical Modalities

The maximum recommended amount has been increased per patient per day, regardless of the number of providers.

2. Range of Motion and Physical Performance Testing

A relative value unit of zero for any provider.

3. Radiologists and MRI Facilities

Imaging studies taken within seven days of the first imaging study shall be subject to reduction.

4. Updated Ground Rules

The new fee schedule includes changes to general, behavioral health, radiology and physical medicine ground rules.

 

Additional Information

In New York, the auto no-fault fee schedule will adopt the state’s Workers’ Compensation Board’s Medical Fee Schedule promulgated on December 11, 2018 and November 19, 2019 for charges for health services performed on or after October 1, 2020, with a few exceptions. The New York State Workers’ Compensation Board made two updates to the medical fee schedule that will not be incorporated into the auto casualty fee schedule:

April 1, 2019

General changes and rates to the Workers’ Compensation Board’s Medical Fee Schedule.

January 1, 2020

Added new fee schedule for acupuncture, amended the billing by physical therapists, self-employed nurse practitioners, physician assistants, licensed social workers and chiropractors. More information about the state’s Workers’ Compensation Board’s Medical Fee Schedule and its amendments can be found here and here. Additionally, the New York no-fault fee schedule will not implement any references in its ground rules regarding time limitations or enhanced reimbursement to providers of certain designated services from the Workers’ Compensation Board’s Medical Fee Schedule.

 

Information for Mitchell DecisionPoint Clients

On July 21, 2020, Mitchell released version 10.6 of its DecisonPoint bill review platform, which includes a comprehensive update to comply with the New York No-Fault Fee Schedule. In order to receive the New York No-Fault Fee Schedule update, Mitchell clients must update their system to version 10.6 prior to the October 1, 2020 fee schedule effective date. For more information about updating to Mitchell DecisionPoint 10.6, please contact your Mitchell client services manager directly. For more information about Mitchell DecisionPoint for non-Mitchell clients, contact us here.