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11 NYCRR 68

 PART 68 – CHARGES FOR PROFESSIONAL HEALTH SERVICES

(Regulation 83)

11 NYCRR 68

 PART 68 – CHARGES FOR PROFESSIONAL HEALTH SERVICES

(Regulation 83)

§ 68.0Preamble

(a)Chapter 892 of the Laws of 1977 provides, as a means of containing the cost of no-fault insurance, for the establishment of schedules of maximum permissible charges for medical, hospital and other professional health services payable under no-fault insurance benefits. Specifically, section 5108(a) of the Insurance Law provides that the charges for services specified in section 5102(a)(1) of the Insurance Law, and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, "... shall not exceed the charges permissible under the schedules prepared and established by the chairman of the Workers' Compensation Board for industrial accidents, except as otherwise provided in section thirteen-a of the Workers' Compensation Law."

(b)Paragraph (1) of subdivision (a) of section 5102 of the Insurance Law defines basic economic loss to include necessary expenses incurred for (i) medical, hospital, surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services; (ii) psychiatric, physical and occupational therapy and rehabilitation; (iii) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of this State; and (iv) any other professional health services.

(c)Section 5102(a) of the Insurance Law provides that for the purpose of determining basic economic loss, the expenses incurred under section 5102(a)(1) shall be in accordance with the limitations of section 5108 of the Insurance Law.

(d)The Superintendent of Insurance is required, after consulting with the chairman of the Workers' Compensation Board and the Commissioner of Health, to promulgate rules and regulations implementing and coordinating the Comprehensive Automobile Insurance Reparations Act and the Workers' Compensation Law regarding the charges for other professional health services, including the establishment of schedules for all such services for which schedules have not been prepared and established by the chairman of the Workers' Compensation Board.

(e)The chairman of the Workers' Compensation Board has to date prepared and established fee schedules for medical, chiropractic and podiatric services. These schedules also include fees for some dental, psychiatric and physical therapy services.

(f)Providers of health services are prohibited from demanding or requesting any payment for services in excess of permissible charges, and the law requires insurers to report to the Commissioner of Health patterns of overcharging, excessive treatment or other improper actions by a health provider.

§ 68.1Adoption of certain workers' compensation schedules

(a)The existing fee schedules prepared and established by the chairman of the Workers'  Compensation Board for industrial accidents are hereby adopted by the Superintendent of Insurance with appropriate modification so as to adapt such schedules for use pursuant to the provisions of section 5108 of the Insurance Law.

(b)

(1) The charges for services specified in paragraph one of subsection (a) of section 5102 of the Insurance Law and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, shall not exceed the charges permissible under the schedules prepared and established by the chair of the Workers' Compensation Board for industrial accidents. However, references to workers' compensation reporting and procedural requirements in such schedules do not apply, e.g., requirements that provide for authorization to perform surgical procedures, is not applicable to no-fault. The general instructions and ground rules in the workers' compensation fee schedules apply, but those rules which refer to workers' compensation claim forms, pre-authorization approval and dispute resolution guidelines do not apply, unless specified in this Part.

(2) If a fee schedule has been adopted for a licensed health provider, the fee for services provided shall be the fee adopted or established for that licensed health provider (for example, the fee for chiropractic services performed by a chiropractor employed by a physician would be the fee applicable for chiropractic services as contained in the Chiropractic Fee Schedule). However, if the Workers' Compensation Fee Schedule contains a specific ground rule to permit reimbursement at the physician rate then that rule will apply. (For example, the fee for services performed by a physical or occupational therapist employed by a physician would be the fee applicable at the physician rate in accordance with Ground Rule Nine contained in the Workers' Compensation Physical Medicine Fee Schedule).

(3) A "licensed health provider" means a licensed healthcare professional acting within the scope of his or her licensure or an entity properly formed in accordance with applicable law and acting within the scope of its license.

§ 68.2Establishment of certain health provider schedules

(a)After consultation with the chairman of the Workers' Compensation Board and the Commissioner of Health, the Superintendent of Insurance hereby establishes fee schedules for professional health services referred to in section 5102(a)(1) of the Insurance Law, and for which schedules have not been prepared and established by the chairman of the Workers' Compensation Board. The schedules for such professional health services, hereby adopted by the Superintendent of Insurance, are incorporated herein as Appendix 17-C and charges for services listed therein shall not exceed the charges permissible under such schedules.

(b)The fee schedules established by the superintendent for professional services referred to in section 5102(a)(1) of the Insurance Law are hereby amended as set forth in Amendment 23 to Appendix 17-C.  Charges for the services listed in the fee schedules, as amended, shall not exceed the charges permissible under such schedules and shall apply to charges for services performed on or after September 1, 1994.

§ 68.3Applicability of limitations

The limitations set forth in this Part for charges by providers of health services apply to all services specified in section 5102(a)(1) of the Insurance Law, and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss. Such limitations shall apply to all health services performed on or after December 1, 1977 with respect to any personal injury arising from the use and operation of a motor vehicle on or after December 1, 1977. Charges for health services performed on or after December 1, 1977 as a result of personal injury due to the use and operation of a motor vehicle prior to such date are not, by statute, subject to the limitations of this Part.

§ 68.4Exception to limitations

A charge in excess of the scheduled fee may be authorized by the insurer, the arbitrator of disputes involving health services or a court of competent jurisdiction, if such insurer, arbitrator or court finds that an unusual procedure or unique circumstance justifies the necessity for such charge. This exception to the fee schedule limitations shall not apply to charges for hospital inpatient services subject to a per diem rate in the hospital fee schedule.

§ 68.5Health services not set forth in schedules

If a professional health service is performed which is reimbursable under section 5102(a)(1) of the Insurance Law, but is not set forth in fee schedules adopted or established by the superintendent, and:

(a)if the superintendent has adopted or established a fee schedule applicable to the provider, then the provider shall establish a fee or unit value consistent with other fees or unit values for comparable procedures shown in such schedule, subject to review by the insurer; or

(b)if the superintendent has not adopted or established a fee schedule applicable to the provider, then the permissible charge for such service shall be the prevailing fee in the geographic location of the provider subject to review by the insurer for consistency with charges permissible for similar procedures under schedules already adopted or established by the superintendent.

§ 68.6Health services performed outside New York State

If a professional health service reimbursable under section 5102(a)(1) of the Insurance Law is performed outside New York State, the permissible charge for such service shall be the prevailing fee in the geographic location of the provider.

§ 68.7Restriction on health provider charges

(a)No provider of health services specified in section 5102(a)(1) of the Insurance Law may demand or request any payment in addition to the charges permitted by the provisions of this Part. If the insured also possesses health insurance coverage and such health insurance contract does not exclude payment for no-fault benefits, payment by the health insurer for health services under such contract is restricted by the limitations of section 5108 of the Insurance Law, unless such limitation would impair the terms of a provider's contract with the health insurer, in which case payment by the health insurer to the provider may be made in accordance with the provider's contract; however, the provider may not receive duplicate payment.

(b)If coverage for health services specified in section 5102(a)(1) of the Insurance Law is provided pursuant to section 5103(g) of the Insurance Law, charges for such health services are restricted by the limitation of section 5108 of the Insurance Law.

(c)This subdivision is applicable to accidents that occurred between December 1, 1977 and December 5, 1980, regardless of the date service was rendered; and to services rendered prior to June 6, 1983 for accidents that occurred on or after December 5, 1980. If a health service provider accepts an assignment of an eligible injured person's Medicare benefits, the provider, for purposes of this Part, is deemed to have contracted with the Social Security Administration. Reimbursement for services rendered to a patient eligible for both No-Fault and Medicare is illustrated by the following example: assume a procedure where a physician's usual and customary charge is $ 50, the Medicare allowable charge is $ 40 and the No-Fault fee schedule amount is $  30:

(1) If the physician takes a Medicare assignment:

(i) Medicare would pay $ 32 (80%);

(ii) No-Fault should be billed $ 8 (20%);

(iii) the No-Fault insurer would be responsible for the amount credited by Medicare to the patient's deductible; and

(iv) physicians should bill Medicare first in the manner they customarily would have billed prior to December 1, 1977.

(2) If the physician does not take Medicare assignments, no contract exists with Medicare, therefore the Insurance Law, section 5108 limitations apply:

(i) Medicare must be billed $ 30 (No-Fault allowance), of which $ 24 (80%) will be paid the physician;

(ii) No-Fault should be billed $ 6 (20%); and

(iii) the No-Fault insurer would be responsible for the amount credited by Medicare to the patient's deductible.

§ 68.8Insurers' reports relating to health providers

(a)Insurers shall report any pattern of overcharging, excessive treatment or any other improper actions by a health provider, within 30 days after such insurer has knowledge of such pattern to the No-Fault Unit, Property Bureau, New York State Insurance Department, 25 Beaver Street, New York, NY 10004, and to the following:

(1) Complaints about:

(i) Physicians and physicians' assistants.

New York State Department of Health

Office of Professional Medical Conduct

New York State Department of Health

433 River Street, Suite 303

Troy, NY 12180

(ii) Hospitals.

New York State Department of Health

Centralized Hospital Intake Program

433 River Street, 6th Floor

Troy, NY 12180

(iii) Other health providers. (complaint should be sent to the nearest office based on the location of the health provider.)

Central Administration
Office of Professional Discipline
New York State Education Department
475 Park Avenue South 2nd Floor
New York, NY 10016-6901

Albany
Office of Professional Discipline
New York State Education Department
80 Wolf Road, 2nd Floor
Albany, NY 12205-2643

Brooklyn, Staten Island
Office of Professional Discipline
New York State Education Department
195 Montague Street, 4th Floor
Brooklyn, NY 11201

Buffalo
Office of Professional Discipline
New York State Education Department
295 Main Street, Suite 756
Buffalo, NY 14203

Bronx/Queens
Office of Professional Discipline
New York State Education Department
2400 Halsey Avenue
Bronx, NY 10461

Mid-Hudson Region
Office of Professional Discipline
New York State Education Department
One Gateway Plaza, 3rd floor
Port Chester, NY 10573

Nassau/Suffolk
Office of Professional Discipline
New York State Education Department
1121 Walt Whitman Road, Suite 301
Melville, NY 11747

Manhattan
Office of Professional Discipline
New York State Education Department
163 West 125th Street, Room 819
New York, NY 10027

Syracuse
Office of Professional Discipline
New York State Education Department
State Tower Building
109 South Warren Street - Suite 320
Syracuse, New York 13202

Rochester
Office of Professional Discipline
New York State Education Department
220 Idlewood Road, Room 106
Rochester, NY 14618

(b)A pattern of overcharging, excessive treatment or any other improper actions is present when such actions involve three or more patients. In determining whether a pattern of overcharging exists, insurers shall not consider as overcharging any charge which is based upon:

(1) a "BR" or "by special agreement" unit value listing in the medical fee schedule;

(2) the presence of unique circumstances or the performance of an unusual procedure, as authorized by section 68.5 of this Part; or

(3) the provider's determination of an appropriate fee consistent with permissible charges for comparable or similar procedures, as authorized by section 68.6 of this Part.

Insurers must designate a claims person in each no-fault claim processing office to maintain a master file of each instance of overcharging, excessive treatment or any other improper action on the part of a health service provider. Notwithstanding the above, insurers shall report any known instance where the claimant has paid the provider the difference between the provider's charge and the maximum allowable fee or where the provider has charged for treatment not rendered.

(c)Reports alleging a pattern of overcharging shall be subject to a hearing by the department in accordance with Part 4 of this Title.

§ 68.9Health services provided through a managed care organization

(a)Notwithstanding any other provision of this Part, a health care provider participating in a certified managed care organization pursuant to an approved managed care program, in accordance with Section 5109 of the Insurance Law, may accept a fee, or agree to bundle services for fees, different than the fees prescribed in this Part, provided that costs for medical and other health care services provided by managed care organizations for an insurer's managed care program shall not, in the aggregate, exceed the costs that would be otherwise payable by application or the fee schedules established by the superintendent or the Chair of the Workers' Compensation Board.

(b)No insurer subject to this Part shall contract with a managed care organization on a capitation basis, unless the managed care organization is:

(1) a health maintenance organization issued a certificate of authority under article 44 of the Public Health Law or licensed under article 43 of the Insurance Law; or

(2) an insurer (including an article 43 corporation) licensed to write accident and health insurance pursuant to the Insurance Law.

.

Appendix 17C

(cf. §  68.3) Introduction. Regional conversion factors are used in the Workers' Compensation medical fee schedule to recognize differences in the cost of conducting a medical practice in various geographic regions of the State. Regional conversion factors were developed after a study was made by the chair of the Workers' Compensation Board.

The components considered in the study made by the chair of the Workers' Compensation Board relative to the cost of conducting a medical practice generally apply to dentists, social workers, speech therapists and optometrists and, while there may be differences in some components, it has been determined by the superintendent that the percentage difference in relative cost by region applicable to physicians is also applicable to the cost of conducting a dental, social worker, speech therapy, optometric practice and by a thermographic technician. This determination will maintain consistency between the schedules established by the chair of the Workers' Compensation Board and specified schedules established by the superintendent under section 5108 of the New York Insurance Law. Regional conversion factors are listed in Parts A, C, D, I and L of this Appendix. For this purpose there are established four regions, based on the differences in the cost of maintaining various health provider practices in different localities of the State. The regions defined in Appendix 17-A of this Title, using United States Postal Service ZIP codes for the State of New York, are hereby adopted as being applicable to Parts A, C, D, I and L of this Appendix.

The fee payable for care and treatment rendered by health care providers in accordance with Parts A, C, D, I and L of this Appendix shall be determined by the region in which the services were rendered. There are hereby established for each region the following regional conversion factors for the indicated Parts of this Appendix:

REGIONAL CONVERSION FACTORS

To determine the maximum allowable fee for a procedure, it is necessary to multiply the unit value by the conversion factor. Example: If the dental procedure designated as procedure 02510 in the dental fee schedule is performed in Region II, the maximum allowable fee is determined by multiplying the unit value, 8.5, by 23.70, the dental conversion factor, i.e., 8.5 x 23.70 = 201.45.

POSTAL ZIP CODES INCLUDED IN EACH REGION

NUMERICAL LIST OF POSTAL ZIP CODES

Part A. Dental fee schedule.

(a)Computation of charges.

(1) The maximum permissible charge for any dental procedure is the product of the unit value shown in the following table of unit values for dental procedures and the regional conversion factor set forth in this Part.

(2) However, for any procedure where the unit value is followed by an asterisk (*), the unit value will generally apply, but a dentist may propose a higher unit value where the range of variation and complexity of the individual case would require a higher unit value. However, such higher unit value must be related to the unit value for other comparable procedures in the schedule. Where reference is made to procedures in the Workers' Compensation surgical fee schedule, the maximum permissible charge for such procedure is the product of the unit value shown in that schedule and the regional conversion factor set forth in that schedule.

(b)Rules governing specialist fees for office, home and hospital visits and consultations.

(1) A dentist who is board-certified in a specialty shall be regarded as a specialist for the purposes of this Part. A dentist who is not board-certified in a specialty shall be paid at three quarters of the fee indicated for a board-certified specialist by submitting to the insurer evidence of qualification as a specialist which is satisfactory to the insurer. If the insurer finds such evidence unsatisfactory, the dentist may appeal the insurer's decision to the arbitrator of disputes involving health service fee schedules.

(2) Specialists rendering services outside their fields of specialization may charge only general practitioner fees. A specialist shall be paid a specialist's fee only if the injuries sustained or the services rendered are within the field of his specialty.

PART A

REGIONAL CONVERSION FACTORS

Effective September 1, 1994

Regional

[1] Region determined by provider's ZIP code.  See page 42.241 for table of ZIP codes.

UNIT VALUES FOR DENTAL PROCEDURES

I.DIAGNOSTIC 00100-00999

Note: Where a fee for an office therapeutic procedure or treatment is in excess of the fee for an ordinary office visit, as, for example, a fee for a minor therapeutic procedure, the greater fee shall be payable.

Specialist Fees (see note following 00157)

Note: The additional fee for consultation or initial examination is payable in instances of elective surgery or when it is incumbent upon the specialist to examine the patient in order to make a proper diagnosis, prognosis, and to decide on the necessity and type of treatment to be rendered. This fee is in addition to the unit fee prescribed for the operation or treatment subsequently rendered by the specialist, except that where a therapeutic procedure or treatment is of a minor character and the fee for the procedure or treatment is in excess of the fee for the office visit, the greater fee (not both fees) is payable.  Similarly, if the fee for the minor procedure or treatment is less than the fee for the office visit, the fee for the office visit alone is payable.

UNIT VALUES FOR DENTAL PROCEDURES

II.PREVENTIVE 01000-01999

UNIT VALUES FOR DENTAL PROCEDURES

III.RETROACTIVE 02000-02999 Diagnostic Procedures--see section I of Part A.

*See (a) (2), supra.

**Nonprecious metal means a chrome alloy.

***Semiprecious metal means an alloy of gold and some other precious metal.

UNIT VALUES FOR DENTAL PROCEDURES

IV.ENDODONTICS 03000-03999 Diagnostic Procedures--see section I of Part A.

UNIT VALUES FOR DENTAL PROCEDURES

V.PERIODONTICS 04000-04999

*See (a)(2), supra.

UNIT VALUES FOR DENTAL PROCEDURES

VI.PROSTHODONTICS--REMOVABLE 05000-05999

Note: The unit values for complete dentures (05110 and 05120) and fixed bridges (06200, 06500 and 06700) include an allowance for temporary dentures; when treatment requires that more than three months elapse between installation of the temporary denture and the permanent denture or fixed bridge,the allowance for the temporary denture (not to exceed a unit value of 8.0) shall be paid upon request of the dentist prior to installation of the permanent denture or fixed bridge, with the remainder being paid after installation of the permanent denture or fixed bridge.

[2]        Payment is to be made only in connection with teeth lost or other damage incurred as a result of a covered accident, except that if usual and proper dental treatment of the injury requires the replacement of additional teeth or other additional procedures, payment will be made for the entire usual and proper treatment.

UNIT VALUES FOR DENTAL PROCEDURES

VII.PROSTHODONTICS, FIXED 06000-06999

Fixed bridges (each abutment and each pontic constitutes a separate unit  in  a bridge; for each pontic the appropriate unit value from code 06200 is applied; for each abutment the appropriate unit value from codes 06500 and 06700 is applied).

* See (a)(2), supra.

** Nonprecious metal means a chrome alloy.

*** Semiprecious metal means an alloy of gold and some other metal.

++ For partial payment related to construction of a temporary denture, see procedure 05800 and subsequent note.

UNIT VALUES FOR DENTAL PROCEDURES

VIII.ORAL SURGERY 07000-07999

Other repair procedures

For procedures not listed below, see section labeled Grafts (or Implants),

starting with Code 20900, Musculoskeletal System, Workers' Compensation

medical fee schedule.

* See (a)(2), supra.

[3]        For nonsurgical treatment of temporomandibular joint dysfunction involving physical medicine procedures or modalities, see the Physical Medicine section or Physical Therapy section of the Workers' Compensation medical fee schedule. For biofeedback treatment, see the Psychiatric Services section of the Workers' Compensation medical fee schedule.

UNIT VALUES FOR DENTAL PROCEDURES

IX.ORTHODONTICS 08000-08999

Note:    The above values are for appliances not associated with comprehensive

case type orthodontic treatment.

UNIT VALUES FOR DENTAL PROCEDURES

X.MISCELLANEOUS GENERAL SERVICES 09000-09999

* See (a)(2), supra.

Part B.Private nursing services fee schedules.

(a)Registered professional nurses. The maximum permissible charge for private nursing services is the local prevailing charge for such services.

(b)Licensed practical nurses. The maximum permissible charge for private nursing services is the local prevailing charge for such services.

Part C.Psychiatric social worker fee schedule.

The maximum permissible charge for any duly licensed psychiatric social worker's services is the product of the unit value shown in the following schedule and the regional conversion factor set forth in this Part. For psychiatric services performed by a physician, see the Workers' Compensation medical fee schedule.

PART C

REGIONAL CONVERSION FACTORS(Effective September 1, 1994)

Regional

Psychological fee schedule.

Please refer to the Workers' Compensation psychology fee schedules.

[1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

Part D.Speech therapy fee schedule.

The maximum permissible charge for any services performed by a qualified speech therapist is the product of the unit value shown in the following schedule and the regional conversation factor set forth in this Part.  For physical and occupational therapy, see the Workers' Compensations medical fee schedule.

2. Comprehensive evaluation and written report by a speech pathologist                 9.8

PART D

REGIONAL CONVERSION FACTORS         (Effective September 1, 1994)

Regional

[1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

Part E.Prescription drugs.

The maximum permissible charge for drugs, which are provided by a licensed pharmacist and require a prescription, is the actual cost of the drug to the druggist (not to exceed the cost shown in the American Druggist Blue Book or Drug Topic Red Book) plus a dispensing fee of $ 5.00, except that for a compounded prescription a $ 2.00 compounding fee shall be added to the dispensing fee.

Note:    In order to minimize the administrative cost, insurers need not verify the maximum permissible charge for the first $ 50 of prescription drug bills received per person, per accident.

Part F.Durable medical equipment, medical/surgical supplies, orthopedic footwear, and orthotic and prosthetic appliances fee schedule.

(a)        The maximum permissible charge for the purchase of durable medical equipment, medical/surgical supplies, orthopedic footwear and orthotic and prosthetic appliances is the fee payable for such equipment and supplies under the New York State Medicaid program at the time such equipment and supplies are provided. If the New York State Medicaid program has not established a fee payable for the specific item, then the fee payable, in accordance with Medicaid rules, shall be the lesser of:

(1) the acquisition cost (i.e. the line item cost from a manufacturer or wholesaler net of any rebates, discounts or other valuable considerations, mailing, shipping, handling, insurance costs or any sales tax) to the provider plus 50%; or

(2) the usual and customary price charged to the general public.

(b)        The maximum permissible monthly rental charge for such equipment, supplies and services provided on a rental basis shall not exceed the lower of the monthly rental charge to the general public or the price determined by the New York State Department of Health area office. The total accumulated monthly rental charges shall not exceed the fee amount allowed under the Medicaid fee schedule.

Part G.Ambulance and other common carrier transportation.

(a)        The maximum permissible charge for ambulance service is the local prevailing charge for such service.

(b)        The maximum permissible charge for other common carrier transportation is the local prevailing charge for such service, based on the most direct route.

Part H.Hearing aid supplies and services.

The maximum permissible charge for hearing aid supplies and services is the actual cost of the hearing aid to the provider, plus:

(a)        in the case of a monaural instrument, a dispensing fee of $ 266;

(b)        in the case of a binaural instrument, a dispensing fee of $ 344.

Part I.              Eye examinations and related services fee schedule.

The maximum permissible charge for eye examinations or related services performed by an optometrist is the product of the unit value shown in the following schedule and the regional conversion factor set forth below:

(for eye examinations and other professional services performed by an ophthalmologist, see the section labeled Ophthalmological Diagnostic and Treatment Services, starting with Code 92002 in the Workers' Compensation medical fee schedule.)

PART I

REGIONAL CONVERSION FACTORS (Effective September 1, 1994)

Regional

[1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

Part J.             Eyeglasses fee schedule.

(a)        The maximum permissible charge for providing and fitting eyeglasses shall be equal to the sum of:

(1) the actual cost of the frames to the provider, not to exceed $ 27.00+, plus a dispensing fee of $ 28.00; and

(2) a charge for obtaining and dispensing lenses, not to exceed $ 51.00 for single vision lenses, $ 82.00 for bifocal lenses, and $ 97.00 for trifocal lenses.

(b)        The maximum permissible charge for providing contact lenses, including dispensing fee, shall be:

(1) hard contact lenses-$ 148.00; and

(2) soft contact lenses-$ 246.00

+          This limitation shall not apply when the frames are identical to or substantially the same design and cost as frames damaged, lost, or otherwise requiring  replacement as a result of an automobile accident; in such case, the maximum permissible charge is the actual cost of the frames to the provider, plus a $ 28.00 dispensing fee.

Part K.             Fee schedule for services rendered in accordance with a religious method of healing.

The maximum permissible charge for nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of the State of New York, by a practitioner accredited to provide such care and treatment is $ 27.00 per day.

.

Appendix 17D (cf. Part 68)

SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL SERVICES

Effective 1/1/85 - 12/31/85

Room other than an operating room when used for minor surgery or emergency treatment:

For the medical service provided, whether by employed staff, attending staff or by contractual arrangement with the physician groups, the fee for this service is the fee as appears on line 90010 of the Schedule of Medical Fees.

For the hospital providing intern or resident staffing or by physician group contractual coverage, the total fee is the fee for physician services as appears on line 90010 of the Schedule of Medical Fees plus the fee for use of the Emergency Service Room as set forth below.

When the care is provided by an attending physician, the hospital fee is the Emergency Service Room fee as set forth below, with the physician billing separately. Note: The above fees include common or ordinary medications.

Crutches, mechanical splints and appliances                       Rental or sale at cost

Plaster cast and/or splint                                                        Cost of plaster

Radium and deep therapy                                                      A & A (authorization and arrangement)

E.K.G., E.E.G., X-RAY, P.T. and laboratory charges Rates in Schedule of Medical Fees

                                                                                                promulgated by the Chairman,

                                                                                                Workers' Compensation Board

Material supplied by the emergency room (i.e., sterile trays, medications, etc.) over and above those usually included with the emergency room visit may be charged for separately. Itemize these on the bill submitted.

COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES

A study was undertaken to determine the low-cost drugs which a large number of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive emergency room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list, or heretofore regarded as common or ordinary, or any additional drugs so regarded, should be considered as covered by the applicable emergency room rate.

No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients. Current List of "No Charge" Drugs and Pharmaceutical Supplies

Emergency service room rate No-Fault -- effective 01/01/85 - 12/31/85

Hospital

Western New York Region

ALLEGANY:

CATTARAUGUS:

CHAUTAUQUA:

ERIE:

GENESEE:

NIAGARA:

ORLEANS:

WYOMING:

CHEMUNG:

LIVINGSTON:

MONROE:

ONTARIO:

SCHUYLER:

SENECA:

STEUBEN:

WAYNE:

YATES:

Central New York Region

BROOME:

CAYUGA:

CHENANGO:

CORTLAND:

HERKIMER:

JEFFERSON:

LEWIS:

MADISON:

ONEIDA:

ONONDAGA:

OSWEGO:

ST. LAWRENCE:

TIOGA:

TOMPKINS:

Northeastern New York Region

ALBANY:

CLINTON:

COLUMBIA:

DELAWARE:

ESSEX:

FRANKLIN:

FULTON:

GREENE:

MONTGOMERY:

OTSEGO:

RENSSELAER:

SARATOGA:

SCHENECTADY:

SCHOHARIE:

WARREN:

WASHINGTON:

Northern Metropolitan Region      

DUTCHESS:

ORANGE:

PUTNAM:

ROCKLAND:

SULLIVAN:

ULSTER:

WESTCHESTER:

Long Island Region

NASSAU:

SUFFOLK:

NEW YORK CITY:

HEALTH AND HOSPITAL CORPORATION:

Text current as of 12/07/2006

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