How to Get Your Telehealth Billing Right- New York Workers’ Compensation


How to Get Your Telehealth Billing Right- New York Workers’ Compensation

Are you employing telehealth to treat New York Workers’ Compensation cases? If yes, and if you are not familiar with telehealth billing for Workers’ Comp cases in New York state, then this article is the right place to begin.

Since most injuries at the workplace are Musculo-skeletal, physical attendance at an authorized provider was always deemed essential. But with the onset of Covid-19 pandemic, it became clear that many minor and non-serious injuries could be treated through telehealth.

So, the New York Workers’ Compensation Board soon established rules and processes regarding coverage and reimbursement of Workers Comp through telehealth.

New York Workers’ Compensation Board COVID-19 response

The New York Workers’ Compensation Board responded to the Covid-19 pandemic by amending their rules to allow telehealth. The Board filed the first emergency telemedicine adoption in March 2020. Since then, the Board has expanded and renewed it. This allows the patients covered by the scheme to get healthcare while maintaining social distancing.

Providers must be aware that other rules remain the same. The rules remain same for the conditions and treatments that are allowed and reimbursed. Treatments not covered for in-person treatment, will not be covered for telehealth either. For smooth billing and reimbursements, attention to coverage is important.

Does it cover Covid-19 disease?

You might be wondering, is Covid-19 acquired through exposure at work, covered by the Workers’ Compensation Board? Yes, it is.

A provider should determine the exposure and confirm the diagnosis by laboratory tests. However, a clinician’s diagnosis will be adequate for cases presenting when the testing was unavailable.

Claims should confirm to the allowed services. Current Workers’ Compensation Board regulations allow for one COVID-19 test per work-related exposure. It neither recommends nor covers testing without a history of exposure. However, workers’ compensation patients who require a COVID-19 test as part of a preoperative test panel before a surgical procedure, will be approved. CT scans are recommended for hospitalized patients with serious disease; not for initial screening or diagnosis (1).

Documentation requirements

In order to ensure that medical records support telehealth services, Security Health Plan requires the following documentations, at a minimum:

  •  Method of telehealth (e.g., secure two-way interactive video connection, phone call, etc.)
  •  Provider location
  •  Listing all clinical participants, roles and actions (e.g., applicable when member presents at a clinic with MD at another location)
  • Member location
  • Providers need to explicitly document the time spent in medical discussion to support the procedure code billed, including start/stop times, if required for the service (e.g., psychotherapy)
  • Providers must document confirmation that a member agrees to receive services via telehealth, verbal consent to receiving telehealth is an acceptable method but must be documented in the medical record
  • Other documentation requirements are the same as a face-to-face encounter

Coding and modifiers for New York Workers’ Compensation Telehealth Billing

Authorized providers can use CPT codes 99212-99214. CPT 99212 will cover Chiropractic/Physical Therapy. For social worker care, use CPT code 90832.

The modifier 95 indicates remote care. Add modifiers 1B and 1D for audio and video consultation and the place of service as 11. However, these modifiers are not available for a telephonic consultation; and the place of service is 2 (2).

Physical therapists can also provide treatment by telehealth. The New York Physical Therapy Association’s website  describes the CPT codes applicable to their various services and processes.

The new amendments also cover Psychotherapy (3). Use the following CPT codes, together with the codes for Evaluation and Management:

  • New patient Evaluation and Management: 99201-99204.
  • Psychotherapy combination codes and crisis codes: 90832-90834, 90836-90840, 90853.

Steps for smooth billing and reimbursements

  • Make sure your authorization as an Authorized Provider is current.
  • Submit medical bills as Form CMS-1500, with a Narrative Report and any supporting documents.
  • File bills with the fee amount prescribed by the NY Workers Compensation Board.
  • When treating the WCB beneficiaries in-person or by telehealth, authorized providers must follow the Medical Treatment Guidelines. These describe the standards of delivery of health care to injured workers.

Providers must obtain medical treatment guideline variance requests, requests for prior approvals, and requests for treatment authorization in the same way as for in-person treatment. The Board has recommendations about the number of visits, duration of treatment, and expense, for each type of injury. Providers need to obtain pre-approval for longer or more expensive treatments. They also need to seek pre-authorization for second surgeries for one injury.

In Summary

The Covid-19 pandemic has accelerated the acceptance of telehealth for everyone, including for New York Workers’ Compensation. Telehealth allows providers to serve beneficiaries with convenience amid social distancing and practices can continue to generate revenue if telehealth coding and billing systems work efficiently for Workers’ Comp cases.

Instead of losing revenue through billing errors, Practice Managers could explore outsourcing this work to a vendor who understands the new rules.


An online consultation is not the same as a regular face-to-face examination and the treating physician/provider may be limited by the written information and imaging provided by the patient or limited by the technology during the encounter. Accordingly, the diagnosis could be limited.
This article does not claim that an online consult is intended to replace a medical face-to-face evaluation fully or partially by a physician.

1. Workers’  Compensation Board Medical Director’s Office Bulletin – MDO-2020 #1 June 26, 2020.
2. Section 325-1.8 of Title 12 New York Codes, Rules and Regulations (NYCRR), amended in 2020 as Covid-19 response.
3. New subdivisions (c) and (d) of section 329-1.3 of Title 12 New York Codes, Rules and Regulations (NYCRR).


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