The Ins & Outs of the N.Y. Fee Schedule

New York, NY (WorkersCompensation.com) -- How much do you know about what the fee schedule in New York involves? Let's have a look.

Purchases

The maximum permissible charge for the purchase of durable medical equipment, medical and surgical supplies, and orthotic and prosthetic appliances is set forth in the December 2023 schedule.

Rentals

The maximum permissible monthly rental charge for equipment, supplies, and services provided on a rental basis shall not exceed the lower of the monthly rental charge to the general public or the price determined by the New York State Department of Health area office.

The total accumulated monthly rental charges shall not exceed the fee amount allowed under the Medicaid fee schedule.

Shipping and Handlings

For purchases and rentals, there are no separate or additional payments for shipping, handling, and delivery.

Self-insured Employers & Carriers

Neither employers nor carriers are allowed to direct a claimant to use a particular supplier of a DME, supplies, or appliances except as part of a certified preferred provider organization. However, self-insured employers and carriers may recommend a supplier.

'Grossly Inadequate'

The chair may make adjustments to the DME fee schedule upon a finding that the reimbursement provided for a particular piece of DME, medical or surgical supply, or other item under the fee schedule is "grossly inadequate" to meet the suppliers' or pharmacies' costs.

Hearing Aids

Hearing aids are not considered durable medical equipment, and the reimbursement is the provider's usual and customary price.

Medicaid

The Medicaid provider manual and the policy guidance for DMEs are not included as part of the DME fee schedule used in workers' compensation cases except to the extent such documents contain the Medicaid DME fee schedule.

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