This is a reminder that mandatory use of the CMS-1500 form went into effect on July 1, 2022, for professional services and durable medical equipment bills/reports. Facility-based services may continue to be billed on a UB-04 or CMS-1450.
You can read more about the requirements and form changes in the GovDelivery dated June 27, 2022.
Important: In the medical narrative attachment that accompanies the CMS-1500 form, health care providers must indicate (either at the top of the narrative, or otherwise prominently displayed) the injured worker’s temporary impairment percentage, current work status, and the causal relationship of the injury or illness.
If any of these elements are missing, the medical narrative report may be found legally defective, which means the injured worker may not receive benefits and you may not be paid for rendered services. You can use the Board’s medical narrative template to ensure you capture these elements.
Additional Resources
Visit the Workers' Compensation Board’s (Board's) website for CMS-1500 news, FAQs, and more. The Board has also created a special webpage dedicated to sharing timely updates on various Board initiatives with a health care provider focus. Visit What Providers Need to Know to view the latest!
For CMS-1500 feedback and questions, email CMS1500@wcb.ny.gov. For clinical feedback and questions, email provider@wcb.ny.gov.
