N.Y. Comp. Codes R. & Regs. tit. 12, § 329-1.3 – Medical fee schedule; incorporation by reference.

(a) The medical fee schedule for medical services shall be the Official New York Workers' Compensation Medical Fee Schedule, updated December 11, 2019, prepared by the board and published by OptumInsight, which is herein incorporated by reference.
(b) The Official New York Workers' Compensation Medical Fee Schedule incorporated by reference herein may be examined at the office of the Department of State, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the board. Copies may be purchased from OptumInsight, by writing to Official New York Workers' Compensation Fee Schedule, P.O. Box 88050, Chicago, IL 60680-9920; by telephone at 1-800-464-3649, option 1; or online at www.optum360coding.com, keyword New York or https://www.optum360coding.com/Product/40508/.
(c) When medically appropriate, authorized providers who utilize the Official New York State Workers’ Compensation Fee Schedule may, when telemedicine is used in accordance with section 325-1.8 of this Title and any applicable Medical Treatment Guideline, bill using the applicable Evaluation and Management codes (99212-99214) using modifier 95 and indicating 11 as the place of service. Modifiers 1B and 1D are available when services are rendered by telemedicine using two-way audio and visual communication. When services are rendered by telephone only in accordance with section 325-1.8 of this Title, the authorized provider shall indicate 02 as the place of service. Modifiers 1B and 1D are not available when services are rendered by telephone with no visual component.
(d) Providers with the following rating codes may bill the following psychotherapy codes in conjunction with Evaluation and Management codes:
1. (1) New patient Evaluation and Management: 99201-99204.
2. (2) Psychotherapy combination codes and crisis codes: 90832-90834, 90836-90840, 90853.
(e) When workers’ compensation benefits are sought due to a work-place exposure to COVID-19, reimbursement for serological, molecular or other reliable testing to confirm a current COVID-19 viral infection may be made using CPT code 87635.
1. (1) The RVU for CPT code 87635 shall be $39.18, and the total fee for such test shall be $51.33 for Region IV, $47.41 for Region III, and $41.53 for Regions I and II.
2. (2) CPT code 87635 may only be billed when there is a claim for workers’ compensation due to a COVID-19 infection as a result of a work-place exposure, or when testing for COVID-19 is administered as part of a required pre-operative testing protocol in accordance with Department of Health guidance.
3. (3) CPT code 87635 may not be billed for routine screening of workers’ compensation claimants for the presence of the COVID-19 virus.
4. (4) Antibody testing is not available under the Official New York Workers’ Compensation Fee Schedule.
5. (5) CPT code 87635 may only be billed in one instance. Repeat testing is not permitted, except when clinical documentation supports a change or reoccurrence of symptoms, or a new exposure to the COVID-19 virus.