Medical Fee Schedules

The Workers' Compensation Board has adopted the NYS Medicaid Durable Medical Equipment (DME) Services Fee Schedule. The most recent version of this fee schedule is found on the Department of Health's eMedNY website. This eMedNY site also provides periodic provider communications, announcements, manuals and fee schedules. Historic fee schedules and other information that is more than four months old can be found in the Archives. The NYS Medicaid DME Services Fee Schedule will be in effect until the OnBoard: Limited Release implementation.

The NYS Medicaid DME Services Fee Schedule will have these exceptions:

1. According to Section 442.2(a) of the Official New York Workers' Compensation DME Fee Schedule (12 NYCRR part 442): For orthopedic footwear (DME codes from L3000 to L3649) or if the New York State Medicaid program has not established a fee payable for the specific item (DME items with a blank reimbursement value in the fee schedule), then the fee payable 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.
2. The following NYS Medicaid DME Services Fee Schedule columns will not be applicable in the Official New York Workers' Compensation DME Fee Schedule:
   1. MAX UNITS: Maximum units allowed per month.
   2. PA: Prior approval.
   3. CHANGE: The CHANGE column indicates a change in the code since the last fee schedule was posted.

Note: The Medicaid provider manual for durable medical equipment and the policy guidance do not apply to workers' compensation except to the extent such documents contain the NYS Medicaid DME Services Fee Schedule. Application of the durable medical fee schedule is based on Workers' Compensation statute, rules and regulations in addition to the durable medical equipment fee schedule. Only the Board in the exercise of its adjudicatory function is authorized to determine entitlement to benefits based on the specific facts of a given claim and the application of the law to those facts. No-fault cases may be subject to differing interpretations. For information regarding no-fault insurance, contact the NYS Department of Financial Services .

Notice of Decision dated April 21, 2009, concerning request for fee schedule adjustment: In the Matter of Request by EMPI, 2009 NY Wrk Comp.

March 30, 2022

• Adoption of Amendments to 12 NYCRR 442.1 and 442.2 (DME Fee Schedule Update)
  • Official New York Workers' Compensation Durable Medical Equipment (DME) Fee Schedule (Effective 4/4/2022)

Resources

• DME Fee Schedule presentation for health care providers - July 2021: Video / Slides
• Official New York Workers' Compensation DME Fee Schedule Frequently Asked Questions