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Workers' Compensation Board

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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-784

Board Files Ambulatory Surgery Fee Schedule Regulations

Date: September 11, 2015

The Board is announcing the adoption of emergency regulations for an Ambulatory Surgery Fee Schedule based on the Ambulatory Patient Groups (APG) system effective October 1st, 2015. Proposed permanent regulations will be filed to adopt an Ambulatory Surgery Fee Schedule based on APG on September 16th, 2015.

Ambulatory Surgery Fee Schedule Background

The Board currently uses Products of Ambulatory Surgery (PAS). Effective October 1, 2015, (consistent with the Centers for Medicare & Medicaid Services (CMS)), the Board will transition to ICD-10 (See Subject No. 046-785). PAS, which utilizes ICD-9, is not compatible with ICD-10. The Board, therefore, must take action to implement an updated ambulatory surgery fee schedule and will transition to the APG-based ambulatory fee schedule effective October 1, 2015.

Regulation

The Chair has adopted emergency regulations and has proposed permanent regulations to use Ambulatory Patient Groups as the ambulatory surgery reimbursement system effective October 1st, 2015. The emergency regulations and proposed permanent regulations will be published in the September 16, 2015 State Register and are available for review on the Board’s website. In addition, the Board has released a transition document providing additional details regarding the implementation of APGs:

   http://www.wcb.ny.gov/content/main/hcpp/MedFeeSchedules/EAPGTransitionDocument.pdf

More information about the APG system and the 3M products that support it are available at:

   http://www.health.ny.gov/health_care/medicaid/rates/apg/index.htm Link to External Website

Feedback

The comment period for the Ambulatory Surgery Fee Schedule will be 45 days. Please email your comments to regulations@wcb.ny.gov no later than November 1, 2015.

 

Robert E. Beloten
Chair