This article outlines New York workers' compensation billing form requirements and provides resources for filing compliant medical bills.
Billing Form Requirements
The table below links to resources on the required forms for compliant workers’ comp billing in New York.
Forms |
Services |
State Resources |
CMS-1500 |
Physician Services |
|
HP-1 |
Payment Appeal |
|
HP-J1 |
Judgment of Award |
|
UB-04 / CMS-1450 |
Institutional/Hospital Claim |
Update: CMS-1500 Initiative
Effective July 2022, the New York State Workers’ Compensation Board (WCB) has implemented the CMS-1500 Initiative, adopting the universal billing form to reduce administrative burden in the workers’ comp medical billing process for providers.
The WCB has phased out use of the forms in the table below.
NY Forms No Longer In Use |
Forms C-4, EC-4: Doctor's Initial Report |
Form C-4.1: Continuation to Carrier/Employer Billing Section |
Forms C-4.2, EC-4.2: Doctor's Progress Report |
Forms C-4AMR, EC-4AMR: Ancillary Medical Report |
Form EC-4NARR: Doctor's Narrative Report |
Forms OT/PT-4, EOT/PT-4: Occupational / Physical Therapist's Report |
Form PS-4: Psychologist's Report |
Form C-5: Ophthalmologist's Report |
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