What Providers Need to Know - Archived Updates
August 28, 2025
Providers subject to electronic CMS-1500 mandate
As of August 1, 2025, all treating healthcare providers in the workers' compensation system are required to submit the CMS-1500 universal billing form electronically, through a Board-approved electronic submission partner, in order to be paid for services.
Read more in a notification dated August 1, 2025.
If you submit a paper CMS-1500 bill on or after August 1, 2025, the payer will not send you payment Instead, the payer will send an Explanation of Benefits or Explanation of Reimbursement that references CARC 16/RARC N34 codes, which indicates your bill was not submitted electronically. In order to be paid, you MUST resubmit the bill to the payer electronically through an approved electronic submission partner within 120 days from the day medical care was rendered.
Read more in a notification dated July 9, 2025.
For easy instructions on how to comply with the mandate, view the CMS-1500 electronic submission fact sheet.
Updated Form C-4.3
The instructions on the Doctor's Report of MMI/Permanent Impairment (Form C-4.3) have been updated and a section requesting billing information has been removed.
While the paper (electronically fillable) version of the form will still be available on the NYS Workers' Compensation Board's (Board's) website, the online submission option through the Board's website has been removed.
Read more in a notification dated August 22, 2025.
New inpatient rates for acute per case inpatient rates, exempt hospitals, exempt units, and chemical dependency detoxification rates, effective January 1, 2025
The NYS Office of Health Insurance Programs has calculated rates of reimbursement for the period January 1, 2025, through December 31, 2025, for acute per case, exempt hospital, exempt unit, and chemical dependency detoxification services.
Read more in Subject Number 046-1773.
Proposed amendments to Section 444.2 of 12 NYCRR (Dental Fee Schedule)
The Chair proposes amendments to Section 444.2 of 12 NYCRR to update the Official New York Workers' Compensation Dental Fee Schedule.
Read more in Subject Number 046-1767.
Adoption of amendments to Sections 440.3, 440.4, and 441.3 of Title 12 of the NYCRR (Network Pharmacies) and notice requirements
Amendment to Network Pharmacy Regulations — Unestablished Injuries The Chair has adopted the amendments to Sections 440.3, 440.4, and 441.3 of 12 NYCRR to provide a path for claimants to obtain medically necessary medication either through use of a network pharmacy or by notice of their ability to use an out-of-network pharmacy.
Read more in Subject Number 046-1766.
Residents and fellows permitted to treat workers' compensation patients
As part of Governor Kathy Hochul's Fiscal Year 2026 Budget signed into law on May 9, 2025, effective immediately, physicians who are training in residency and fellowship programs accredited by the Accreditation Council on Graduate Medical Education (ACGME) are permitted to treat injured workers in New York State under the appropriate supervision of faculty physicians (see Workers' Compensation Law Section 13-b[2][b-2]).
Read more in Subject Number 046-1756R and in the Board's press release: https://www.wcb.ny.gov/content/main/PressRe/access-medical-treatment.jsp.
Also check out a new dedicated webpage for resident and fellow physicians at: https://www.wcb.ny.gov/content/main/hcpp/residents-fellows.jsp.
Reminders
- Interested in treating injured workers? If you are interested in applying for Board authorization to treat injured workers, the process is easy and is done online. Read more about becoming authorized on the Board's website.
- The What Providers Need to Know section of the Board's website features a one-stop-shop that walks health care providers through getting started in the workers' compensation system, treating injured workers, billing for services, and more.
- Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613.
- Use of the CMS-1500 form is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS1500@wcb.ny.gov.
- Visit the Board's website for OnBoard training guides, webinar recordings, and other resources.
- Efficiency Enhancements is a new communication with tips and best practices on using Board systems, processes, and forms in the most efficient, effective manner. Sign up to receive these, and other updates, straight to your inbox.
- The latest versions of several Paid Family Leave presentations are available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
Stay informed!
Check out Recorded Webinars for health care providers on the Board's website. Health Care Providers Recorded Webinars web page for past webinars.
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