New York Workers' Compensation Medical Billing Guide

This Billing Guide outlines New York’s workers' compensation billing requirements and daisyBill’s resources for filing compliant medical bills.

Billing Form Requirements

This table is a guide to daisyBill's resources on the required forms for compliant paper and electronic workers’ comp billing in New York.

Forms	Services	daisyBill 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	Facility

*See the CMS-1500 Initiative update

UPDATE: CMS-1500 Initiative

The New York State Workers’ Compensation Board (NYS WCB) has implemented the CMS-1500 Initiative, adopting the form to reduce administrative burden in the workers’ compensation medical billing process for providers. The following forms are to be phased out and replaced with the CMS-1500 Form:

Form	Name
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

State-Mandated Physician Reporting Requirements

While the WCB phases out the above reporting requirements in favor of the CMS-1500, the Initiative requires a Narrative Report to accompany each CMS-1500 Form. This table is a guide to the Narrative Report requirements for compliant paper and electronic workers’ comp billing in New York.

Service	Obsolete Requirement	New Requirement	Due	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	CMS-1500 & Narrative Report	Within 48 hours of the first treatment.	Initial Narrative
Progress Report	Doctor's Progress Report	CMS-1500 & Narrative Report	15 days after the first treatment 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	Doctor's Report of MMI / Permanent Impairment	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
OT / PT	Occupational Therapist's / Physical Therapist's Report	CMS-1500 & Narrative Report	Within 48 hours of first treatment. 15 days after treatment is first rendered. At 90 day intervals while continuing treatment.	OT / PT Narrative
Ophthalm- ology	Attending Ophthalmologist's Report	CMS-1500 & Narrative Report	Within 48 hours of first treatment. 15 days after treatment is first rendered. At 90 day intervals while continuing treatment.	Ophthalmology Narrative
Psychology	Psychologist's Report	CMS-1500 & Narrative Report	Within 48 hours of first treatment. 15 days after treatment is first rendered. At 90 day intervals while continuing treatment.	Psychology Narrative

Electronic Billing Mandate

Healthcare providers in the state should file their bills electronically. The state of New York has issued electronic billing regulations for medical bills but is currently in transition. Mandatory electronic filing will be effective eventually.

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