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 |
|
HP-1 |
Payment Appeal |
|
HP-J1 |
Judgment of Award |
|
UB-04 / CMS-1450 |
Institutional/Hospital Claim |
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. |
|
Initial Report |
Doctor's Initial Report (Forms C-4, EC-4) |
CMS-1500 & Narrative Report |
Within 48 hours of the first treatment. |
|
Progress Report |
Doctor's Progress Report (Forms C-4.2, EC-4.2) |
CMS-1500 & Narrative Report |
Within 15 days after the initial report |
|
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; |
|
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. |
|
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. |
|
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. |
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).
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