Effective April 1, 2019
I was so excited to receive my brand-new Worker’s Compensation Medical Fee Schedule binder yesterday! All No-Fault and Worker’s Compensation medical services, including Acupuncture, Physical Therapy, Massage Therapy, Orthopedic, PM&R, and Neurology are affected by these revisions.
There are many changes since the last time this book was published in 2012. Let’s look at the most important so that you can start billing for your services correctly on April 1:
In both the Medical and Chiropractic Guidelines, the conversion factors have increased. For instance, if you are an M.D. practicing in Region IV, your old E/M CV was $ 10.99. As of April 1, it’s $ 15.06. If you are a Chiropractor or Acupuncturist, your old EM CV was $ 5.78. As of April 1, it will be $ 7.92.
Additionally, new Conversion Factor line items have been added to the Chiropractic Fee Schedule, so Medicine and Physical Medicine is now broken out from Evaluation and Management and each given their own Conversion Factors.
As an illustration, here is what a typical Long Island-based Acupuncturist-LMT (Region IV) would be billing under the new Fee Schedule:
|Service||Conversion Factor (Chiro rate)||RVU||Total|
|99203 New Patient Consult 30 min||$ 7.92||9.47||$ 75.00|
|99212 Est. Patient Consult 10 min||$ 7.92||4.57||$ 36.19|
|97810 Acupuncture w/out estim initial 15||$ 7.57||3.55||$ 26.87|
|97811 Acupuncture w/out estim reinsert||$ 7.57||3.04||$ 23.01|
|97813 Acupuncture w/estim initial 15||$ 7.57||3.89||$ 29.45|
|97814 Acupuncture w/estim reinsert||$ 7.57||3.38||$ 25.59|
|97026 Infrared Lamp||$ 7.17||2.54||$ 18.21|
|97124 Massage, 15 minutes||$ 7.17||2.62||$ 18.79|
|97140 Manual Therapy, 15 minutes||$ 7.17||4.23||$ 30.33|
Cupping/Moxa would fall under Physical Medicine, so the Conversion factor would be $ 7.17
An MD-LAc would bill the following rates under the new Fee Schedule:
|Service||Conversion Factor (MD rate)||RVU||Total|
|99203 New Patient Consult 30 min||$ 15.06||9.47||$ 142.62|
|99212 Est. Patient Consult 10 min||$ 15.06||4.57||$ 68.82|
|97810 Acupuncture w/out estim initial 15||$ 11.07||3.55||$ 39.30|
|97811 Acupuncture w/out estim reinsert||$ 11.07||3.04||$ 33.65|
|97813 Acupuncture w/estim initial 15||$ 11.07||3.89||$ 43.06|
|97814 Acupuncture w/estim reinsert||$ 11.07||3.38||$ 37.42|
|97026 Infrared Lamp||$ 10.48||2.54||$ 26.62|
|97124 Massage, 15 minutes||$ 10.48||2.62||$ 27.46|
|97140 Manual Therapy, 15 minutes||$ 10.48||4.23||$ 44.33|
Cupping/Moxa would be included under Physical Medicine, so the conversion factor would be $ 10.48
Maximum Daily RVUs
Prior to April 1, 2019, the maximum daily RVU’s for certain combined Physical Medicine modalities was 8.0, unless an E/M code was used, which would bump it to 13.5. Under the new Fee Schedule, the maximum daily RVU has been increased to 12.0 RVUs per day, with the caveat that this max is across the board for all providers in a given day (thereby dispensing with the Doctor of Medicine in The House Hackeling decision out of Huntington). You can still add your E/M code on the dates they are performed with your physical medicine.
Additional/New/Deleted CPT Codes
New CPT codes have been added to the Chiropractic Fee Schedule, including EMG and Nerve Conduction Studies, each having their own RVU, and new Radiology codes have been added. Descriptions have been amended for Evaluation and Management codes 99201, 99202,99203,99204 and 99212. The list of changed and amended codes is much longer for Medical Doctors/Doctors of Osteopathy, ect. as is the list of deleted codes.
New Behavioral Health Chapter
Behavioral health gets its own subdivision in the newest edition, complete with its own conversion factors. I know this will be a big help to my Psychology, Psychiatry and CSW practitioners.
Most importantly, you should purchase the Fee Schedule book so that you can start to bill correctly as of the effective date. Copyright laws do not allow me to post portions of the fee schedule book here for obvious reasons. You can obtain the binder through Optum’s website. It is a smart investment for your practice.
I also recommend that you familiarize yourself with the Ground Rules that introduce each chapter of the Fee Schedule which applies to you. However, if you have any specific questions, you can feel free to contact me via email at [email protected]. I have assisted medical providers in proper fee scheduling and in New York No Fault arbitrations for over eleven years. And, prior to that, I worked inside different insurance companies, so I have a unique perspective. I am also available for webinars on New York No-Fault subjects that are of importance or interest.