The new Medical Fee Schedule (Pathology and Laboratory section, Ground Rule 12), updating the reimbursement for services to injured workers, takes effect April 1, 2019. The NYS Workers Compensation recently issued guidance on clarifying that the Non-Acute Pain Medical Treatment Guidelines recommendations govern urine drug testing.
An excerpt of the Non-Acute Pain Medical Treatment Guideline criteria is provided as a reference.
The new Medical Fee Schedule incorporates standards from the Board’s 2014 Non-Acute Pain Medical Treatment Guidelines and offers guidance as to the frequency of urine drug testing based on the level of risk for each patient. The updated rules do not contain the same level of detail, medical analysis and instructions as are contained in the Board’s Non-Acute Pain Medical Treatment Guidelines. Every medical provider should always use any applicable Medical Treatment Guideline when providing treatment and care to a workers’ compensation patient.
The Medical Fee Schedule states in every section that the Medical Treatment Guidelines set forth the standard of care and will prevail when there is a conflict between the two documents.
In Ground Rule 12, the Medical Fee Schedule identifies low/moderate/high risk test results and behavior and provides guidance as to how frequently urine drug testing may be performed in a medical provider’s office. The chart in the Ground Rule indicates that testing should be performed at different frequencies depending on a patient’s level of risk. The NAP-MTG on page 54 includes a similar chart. The chart in the NAP MTG sets forth that urine drug testing should be performed at least the annual allowable indicated for the applicable level of risk. The NAP MTG provide more detail and set forth the medical standards required for managing patients being treated for non-acute pain management.
As set forth on page 54 of the Non-Acute Pain Medical Treatment Guidelines, Risk Category (Score) and Random UDT Frequency:
• Low Risk patients should be tested at least once per year
• Moderate Risk patients should be tested at least twice per year
• High Risk patients should be tested at least 3-4 times per year
• Any patient demonstrating aberrant behavior should be tested at the time of visit
For more information, please review the Non-Acute Pain Medical Treatment Guidelines, First Edition, September 15, 2014.