Frequently Asked Questions
If I am a NYS licensed provider, can I treat NYS workers' compensation claimants in other states?
Yes, if you are licensed in the other state and the claimant resides in that state. However, any NYS licensed provider treating a worker's compensation claimant in New York State must be authorized by the Board to treat injured workers.
If treatment is rendered out of state for a claimant who resides out of state, how is the bill reimbursed if the provider is Board authorized?
A provider who is Board authorized will be reimbursed at the NYS WCB Medical Fee Schedule rate regardless of where treatment is rendered if it is a NYS workers' compensation claim in accordance with 12 NYCRR 329-1.3, 12 NYCRR Part 329-4, 12 NYCRR Part 333, and 12 NYCRR 348.2.
If treatment is rendered out of state for a claimant who resides out of state, how is the bill reimbursed if the provider is not Board authorized?
A provider who is not Board authorized will be reimbursed at the fee schedule rate in the state where treatment was rendered. If there is no fee schedule for that state, payment will be at the prevailing rate in the community for similar treatment. The Board may require documentation of the prevailing rate from provider.
If treatment is rendered out of state, but the claimant resides in NYS, how is the bill reimbursed?
Claimants who reside in NYS may treat with an out-of-state provider or a provider who is licensed and qualified in the state where treatment is rendered. Such treatment shall conform to the Workers' Compensation Law and regulations, the MTGs, and the Medical Fee Schedule. The regional conversion factor for the ZIP code where the claimant resides shall be used in payment of the bill.