Telehealth is an increasingly important component of medical treatment, including for workers’ comp patients.

New York providers treating injured workers must know the rules regarding when telehealth care is permissible (and payable). In this first part of our series on telehealth for New York State workers’ comp, below we break down:

• Which types of providers may treat injured workers via telehealth
• Technical (i.e., video and/or audio) and other requirements for administering treatment via telehealth

See the telehealth details below.

NY Providers Eligible to Treat via Telehealth

According to the New York State Workers’ Compensation Board (WCB) telehealth web page, only certain types of providers may treat using telehealth, subject to “proper context” and/or “timing” (explained below):

“Proper context” refers to the appropriateness of administering telehealth care, as described in New York Codes, Rules, and Regulations (CRR) Section 325-1.26.

Per CCR § 325-1.26(c)(2), telehealth is not “medically appropriate” in all of the following situations. Examples include, but are not limited to:

• Procedures - Health concerns requiring a procedure.
• Urgent symptoms - Issues like abdominal pain, chest pain, mental status changes, risk of harm to self or others, severe headaches, stroke symptoms, or any other conditions needing immediate, in-person emergency or urgent care.
• Eye complaints - Vision or eye-related issues requiring direct assessment.
• Complex cases - Multiple or nuanced health concerns needing in-person evaluation to understand interactions between conditions or medications.
• Accuracy and quality of care - Situations where an in-person exam improves the precision, quality, or reliability of assessment or treatment.
• Disability or range of motion - Assessments requiring physical testing (i.e., strength, range of motion, joint stability, nuanced orthopedic/neurological evaluations, or pulmonary function testing).
• Physical modalities - Physical, occupational, or chiropractic care requiring direct physical interaction beyond exercise guidance.
• Board guidelines - Other cases specified in the Medical Treatment Guidelines (MTG) or Board communications.
• Causal relationship assessments - Determining the cause of an injury. If a provider determines an in-person exam is unnecessary to decide on the cause of injury, they must clearly explain why telehealth is sufficient in their medical record.

Per CCR § 325-1.26(c)(3), telehealth is not medically appropriate in certain other situations, regardless of whether specific criteria for telehealth are established. Examples include, but are not limited to:

• Urine drug testing
• Initial prescription or follow-up monitoring of medications (without periodic in-person evaluation)
• The treatments outlined in the MTG that necessitate in-person examination
• Assessment of permanent disability
• Clinical scenarios outlined by the WCB in Medical Treatment Guidelines or other communications
• The injured worker lacks the necessary technology or equipment for telehealth
• The patient has physical or cognitive challenges that prevent effective telehealth care
• The patient specifies a preference for in-person services and can attend
  

“Timing” refers to the phase of the injury and the amount of time since the date of injury. Physicians, podiatrists, nurse practitioners, and physician assistants must treat in person as follows:

• For the initial visit
• At least every third visit during the first three months following the date of injury (the acute/subacute phase)
• No less than every three months, once three months have passed from the date of injury (if chronic but before Maximum Medical Improvement, or MMI)
• At least annually, once the injured worker has reached MMI

As indicated in the table above, timing or the phase of injury does not apply to psychologists and LCSWs treating via telehealth. However, these providers are subject to “proper context” criteria.  Behavioral health telehealth visits are permissible when:

• There is no added benefit to in-person treatment or
• In-person treatment poses an undue risk or hardship to the injured worker

CCR §325-1.26(b)(2)(iv) instructs psychologists and LCSWs to document the reason for utilizing telehealth in the required medical narrative portion of the provider’s report.

Telehealth Technology and Other Requirements

New York allows providers to treat injured workers via telehealth in either of two ways:

• Two-way audio and visual communication (e.g., video calls)
• Audio-only communication (e.g., telephone)

Further, New York Codes, Rules, and Regulations (CRR) Section 325-1.26(a) mandates that all providers adhere to the following requirements even when utilizing telehealth:

1. In-Person Availability: Providers must maintain an office within a reasonable distance from the injured worker’s home and be available to see the injured worker if necessary.

2. Compliance with the Medical Treatment Guidelines (MTGs): Providers must adhere to the MTGs when treating injured workers via telehealth.

New York does not allow claims administrators to object to payment solely based on the use of telehealth, so long as the provider delivers telehealthcare according to state rules.

Stay tuned for more guides to telehealth billing for New York workers’ comp—we have lots more to cover!

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