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Workers’ Compensation Board

Overview


In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) has made a strategic decision to adopt the CMS-1500 form.

Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500 form, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers. Careful review and discussion with various stakeholders confirms that the CMS-1500 is easy to use and provides all the necessary information.

The Board will replace the following forms with the CMS-1500:

  • Doctor's Initial Report (Forms C-4, EC-4)
  • Continuation to Carrier/Employer Billing Section (Form C-4.1)
  • Doctor's Progress Report (Forms C-4.2, EC-4.2)
  • Ancillary Medical Report (Forms C-4AMR, EC-4AMR)
  • Doctor's Narrative Report (Form EC-4NARR)
  • Occupational/ Physical Therapist's Report (Forms OT/PT-4, EOT/PT-4)
  • Psychologist's Report (Form PS-4)
  • Ophthalmologist's Report (Form C-5)

As the CMS-1500 is already used by virtually all medical providers and insurance carriers, the Board anticipates a relatively smooth transition to the CMS-1500. The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.

The Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers’ compensation patients.

You can view the video here: CMS-1500 Training VideoLink to External Website

Questions can be directed to: CMS1500@wcb.ny.gov

Recent News


November 22, 2019

September 26, 2019

September 6, 2019


To see earlier announcements, visit the CMS-1500 News page.