View Other Articles

Billing Guide

Last update
April 2, 2025

This guide outlines New York workers' compensation billing 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

CMS-1500 Instructions

HP-1

Payment Appeal

HP-1 Instructions

HP-J1

Judgment of Award

HP-J1 Instructions

UB-04 / CMS-1450

Institutional/Hospital Claim

WCB FAQ

UPDATE: CMS-1500 Initiative

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

e-Billing for MMI/Permanent Impairment

For e-billing, providers must submit the CMS-1500, not Form C-4.3, as the billing form when rendering a decision on MMI and/or permanent impairment. However, providers must submit Form C-4.3 as the required narrative report accompanying the CMS-1500 bill. Do not submit Form C-4.3 separately from the CMS-1500.

NY Form Replaced by CMS-1500, But Still in Use for Narrative Reporting

Forms C-4.3: Doctor's Report of MMI / Permanent Impairment

State-Mandated Physician Reporting Requirements

The WCB initiative requires a Narrative Report to accompany each CMS-1500 Form. The table below lists the Narrative Report requirements.

Service

Old Requirement

Current Requirement

Deadline

 Form / Requirements Link

Medical Bill

CMS-1500 & Narrative Report

Within 90 days of the last day of the month in which services are rendered.

Narrative Report Instructions

Initial Report

Doctor's Initial Report (Forms C-4, EC-4)

CMS-1500 & Narrative Report

Within 48 hours of the first treatment.

Initial Narrative 

Progress Report

Doctor's Progress Report (Forms C-4.2, EC-4.2)

CMS-1500 & Narrative Report

Within 15 days after the initial report

For each follow-up visit scheduled when medically necessary while treatment continues but not more than 90 days apart.

Subsequent Narrative

MMI Report

Doctor's Report of MMI / Permanent Impairment (Form C-4.3)

Doctor's Report of MMI / Permanent Impairment (Form C-4.3)*

This reporting requirement remains unchanged.

When rendering an opinion on MMI and/or permanent impairment;

In response to a request by the WCB to render a decision of MMI and/or permanent impairment.

C-4.3 

PT/OT

Occupational Therapist's / Physical Therapist's Report (Forms OT/PT-4, EOT/PT-4)

CMS-1500 & Narrative Report

Within 48 hours of first treatment.

Within 15 days after treatment is first rendered.

At 90 day intervals while continuing treatment.

PT/OT Narrative

Ophthalm- ology

Attending Ophthalmologist's Report (Form C-5)

CMS-1500 & Narrative Report

Within 48 hours of first treatment.

Within 15 days after treatment is first rendered.

At 90 day intervals while continuing treatment.

Ophthalmology Narrative

Psychology

Psychologist's Report (Form PS-4)

CMS-1500 & Narrative Report

Within 48 hours of first treatment.

Within 15 days after treatment is first rendered.

At 90 day intervals while continuing treatment.

Psychology Narrative

Electronic Billing Mandate

Effective August 1, 2025, all NY providers must file their bills for injured worker treatment electronically (e-billing).

Claims administrators are required to accept providers’ e-bills and respond with electronic Explanations of Review/Explanations of Benefits.

Providers must also send bill data for every bill to the WCB in the mandatory XML file form, through one of eight WCB-approved XML Submission Partners (which includes daisyBill).

Stay Up to Date

Subscribe to daisyNews to get the latest updates as the mandatory e-billing deadline approaches.

SUBSCRIBE TO DAISYNEWS

How did you like the article ?