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Workers' Compensation Board

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Medical Care Fee Schedules


Revised Proposed 2018 Medical Fee Schedule For Public Comment (October 3, 2018)

Calculating Medical Reimbursement Fees

The methodology for calculating medical reimbursement fees remains unchanged. Fee schedules are both region and activity-specific. To calculate a fee for a particular procedure:

  • Identify the appropriate conversion factor, which is listed within the respective Ground Rules document. There is a conversion factor for each geographic region* and general type of medical service provided (e.g., surgery, radiology, etc.). For example, in the Medical Ground Rules document, you'll find the conversion factor table on page 12.
  • Once you have the conversion factor you need, find the CPT code for the specific type of service you want to look up.
  • For each CPT code, there is a Relative Value Unit (RVU) listed.
  • Multiply the RVU by the conversion factor to calculate the fee for that service.

The only element not published on the Board's website are the CPT code descriptions, which are owned by the American Medical Association and available by purchase or subscription. Providers and insurance carriers already have this information as it is industry-standard material. Those who do not have access to CPT codes with descriptions can arrange to review them in person at Board offices by contacting regulations@wcb.ny.gov

*Regions I and II factors are now identical.


Proposed 2018 Medical Fee Schedule For Public Comment (June 6, 2018)

Review Proposed Medical Fee Schedules published on June 6, 2018