NY Billing Alert: Payers Deny CPT 99080 for 64% of e-Bills
As of August 1, 2025, New York mandates that providers submit all bills for injured workers’ medical treatment electronically (e-billing).
To offset the cost of e-billing for practices, the New York Workers’ Compensation Board (WCB) began requiring payers to reimburse providers up to $1 per e-bill when the provider lists procedure code CPT 99080 on their e-bill, effective August 1, 2024.
So far, payers frequently defy the WCB and refuse to reimburse CPT 99080.
daisyData from January through July of this year demonstrate that payers collectively failed to reimburse CPT 99080 charges on 64% of e-bills providers sent through daisyBill. This amounts to over 20,000 violations of the WCB's mandate to reimburse providers for adopting e-billing.
daisyBill has shared this data with the WCB, in the expectation that the agency will impose appropriate consequences on the offending payers.
See our data below, including non-compliance rates by each payer.
CPT 99080 for NY Workers’ Comp e-Billing
New York instituted mandatory e-billing to reduce the administrative burden on providers of treating injured workers and collect real-time data on each claim. To submit e-bills in New York, providers must work with one of six WCB-approved e-billing partners.
The results so far: faster payment, verified and timestamped documentation of bill delivery, and easier overall revenue management for practices.
However, the WCB recognized that adopting new technology comes at a cost for providers. The agency repurposed CPT 99080, previously a “No Charge” code, to allow providers to bill the payer for each e-bill, up to $1.00.
A WCB bulletin (below) made it clear: payers must honor CPT 99080 for all e-bills providers submit on or after August 1, 2024.
daisyData: CPT 99080 Denials by Month
daisyData indicate that payers often ignore the WCB’s clear directive to reimburse providers when they bill CPT 99080.
Out of 37,007 e-bills New York daisyBill providers submitted from January 1, 2025 through July 31, 2025, payers failed to reimburse 99080 for 20,063.
Generally, non-compliance decreased as the year progressed and daisyBill providers submitted more e-bills (dropping from 89% in January to 56% in July). Regardless, no amount of non-compliance is acceptable.
At $1.00 per violation, payers improperly withheld $20,063 (and counting) from providers who are complying with state mandates.
NY e-Bill Submission Month |
Count of e-Bills Sent With CPT 99080 |
CPT 99080 Paid Count |
CPT 99080 Paid % |
CPT 99080 Denied Count |
CPT 99080 Denied % |
Jan 2025 |
334 |
29 |
11% |
231 |
89% |
Feb 2025 |
1,976 |
278 |
17% |
1,379 |
83% |
Mar 2025 |
2,718 |
327 |
14% |
1,942 |
86% |
Apr 2025 |
8,790 |
1,410 |
20% |
5,669 |
80% |
May 2025 |
7,421 |
3,206 |
49% |
3,386 |
51% |
Jun 2025 |
6,724 |
2,864 |
47% |
3,248 |
53% |
Jul 2025 |
9,044 |
3,295 |
44% |
4,208 |
56% |
Totals |
37,007 |
11,409 |
36% |
20,063 |
64% |
daisyData: 99080 Violations by Payer
The WCB instructed providers not to file Requests for Decision on Unpaid Medical Bill(s) (Form HP-1.0) to dispute 99080 denials, instead asking providers to track and report repeated violations by specific payers.
Accordingly, daisyBill is tracking 99080 denials and sharing those data with the WCB.
Below are the data we shared for each claims administrator daisyBill providers billed from January 1, 2025 to July 31, 2025 reporting two types of violations:
- Failure to remit electronic Explanations of Review in response to e-bills
- Failure to reimburse for CPT 99080
Most significantly:
- 40 payers denied payment for CPT 99080 for 100% of e-bills
- 85 payers denied CPT 99080 for 50% or more of e-bills
- Sedgwick Claims Management Services, Inc., the largest workers’ comp Third-Party Administrator in the US, denied payment for CPT 99080 for 61% of e-bills
New York is taking decisive action to update and improve its workers’ comp system. With new requirements in place, the state must now meet the challenge of enforcement.
daisyBill will continue to support providers and assist the WCB by sharing our data.
Claims Administrator |
e-Bill Count (Includes 99080 Charge) |
e-Bills Missing e-EOR Count |
e-Bills Missing e-EOR % |
CPT 99080 Paid Count |
CPT 99080 Paid % |
CPT 99080 Denial Count |
CPT 99080 Denial % |
New York State Insurance Fund |
15,701 |
1,391 |
9% |
5,924 |
41% |
8,386 |
59% |
Sedgwick Claims Management Services, Inc. |
3,207 |
341 |
11% |
1,120 |
39% |
1,746 |
61% |
New York City Law Department |
1,787 |
1,285 |
72% |
191 |
38% |
311 |
62% |
Gallagher Bassett Services Inc. |
1,465 |
20 |
1% |
178 |
12% |
1,267 |
88% |
CorVel |
1,396 |
142 |
10% |
638 |
51% |
616 |
49% |
Travelers |
1,124 |
3 |
0% |
90 |
8% |
1,031 |
92% |
The Black Car Fund |
1,105 |
8 |
1% |
671 |
61% |
426 |
39% |
PMA Companies |
889 |
16 |
2% |
396 |
45% |
477 |
55% |
The Hartford |
809 |
31 |
4% |
339 |
44% |
439 |
56% |
ESIS, Inc. |
649 |
38 |
6% |
5 |
1% |
606 |
99% |
Liberty Mutual Insurance |
646 |
9 |
1% |
130 |
20% |
507 |
80% |
AmTrust North America, Inc. |
642 |
45 |
7% |
27 |
5% |
570 |
95% |
JAG Source IPA, LLC Network |
614 |
226 |
37% |
5 |
1% |
383 |
99% |
Chubb Group of Insurance Companies |
523 |
31 |
6% |
425 |
86% |
67 |
14% |
NCA Comp, Inc. |
507 |
14 |
3% |
113 |
23% |
380 |
77% |
Helmsman Management Services LLC |
440 |
14 |
3% |
60 |
14% |
366 |
86% |
The Risk Management Planning Group, Inc. |
396 |
349 |
88% |
2 |
4% |
45 |
96% |
Broadspire Services, Inc. |
383 |
17 |
4% |
67 |
18% |
299 |
82% |
Zurich Insurance North America |
379 |
3 |
1% |
28 |
7% |
348 |
93% |
New York City Police Department (NY) |
379 |
379 |
100% |
0 |
0% |
0 |
0% |
Triad Group |
330 |
94 |
28% |
7 |
3% |
229 |
97% |
SAFE LLC |
295 |
26 |
9% |
228 |
85% |
41 |
15% |
Wright Risk Management Company, LLC |
260 |
198 |
76% |
49 |
79% |
13 |
21% |
Maine Employers Mutual Indemnity Company |
171 |
5 |
3% |
86 |
52% |
80 |
48% |
FCS Administrators, Inc. |
167 |
8 |
5% |
103 |
65% |
56 |
35% |
National Liability and Fire Insurance Company |
167 |
1 |
1% |
0 |
0% |
166 |
100% |
Hereford Insurance Company |
156 |
104 |
67% |
3 |
6% |
49 |
94% |
Cannon Cochran Management Services, Inc. |
144 |
9 |
6% |
42 |
31% |
93 |
69% |
Benetech, Inc. |
137 |
3 |
2% |
90 |
67% |
44 |
33% |
Crum & Forster |
123 |
1 |
1% |
59 |
48% |
63 |
52% |
Oriska Insurance |
119 |
119 |
100% |
0 |
0% |
0 |
0% |
Guard Insurance Group |
110 |
11 |
10% |
2 |
2% |
97 |
98% |
None |
105 |
97 |
92% |
3 |
38% |
5 |
63% |
New Jersey Manufacturer's Insurance Group |
100 |
3 |
3% |
63 |
65% |
34 |
35% |
Utica Mutual Insurance Co |
71 |
11 |
15% |
0 |
0% |
60 |
100% |
FutureComp |
66 |
58 |
88% |
2 |
25% |
6 |
75% |
Sentry Insurance |
66 |
0 |
0% |
41 |
62% |
25 |
38% |
MSA Careguard |
64 |
64 |
100% |
0 |
0% |
0 |
0% |
Erie Insurance Group |
64 |
3 |
5% |
7 |
11% |
54 |
89% |
ARGO - Argonaut Insurance Company |
63 |
0 |
0% |
0 |
0% |
63 |
100% |
Applied Underwriters |
54 |
14 |
26% |
15 |
38% |
25 |
63% |
Berkshire Hathaway Homestate Companies |
53 |
17 |
32% |
18 |
50% |
18 |
50% |
Retail Business Services, LLC |
53 |
2 |
4% |
27 |
53% |
24 |
47% |
biBERK |
53 |
7 |
13% |
0 |
0% |
46 |
100% |
CNA Insurance |
50 |
10 |
20% |
17 |
43% |
23 |
58% |
Selective Insurance |
49 |
2 |
4% |
0 |
0% |
47 |
100% |
National Casualty Company |
48 |
0 |
0% |
0 |
0% |
48 |
100% |
Utica National Insurance Co of Texas |
45 |
9 |
20% |
3 |
8% |
33 |
92% |
Tristar Risk Management |
36 |
10 |
28% |
16 |
62% |
10 |
38% |
Employers Compensation Insurance Company |
35 |
11 |
31% |
8 |
33% |
16 |
67% |
Next Level Administrators |
34 |
2 |
6% |
9 |
28% |
23 |
72% |
Marriott Claims Service Corp |
33 |
15 |
45% |
1 |
6% |
17 |
94% |
GCG Risk Management, Inc. |
31 |
2 |
6% |
13 |
45% |
16 |
55% |
Carisk Imaging Network |
30 |
26 |
87% |
0 |
0% |
4 |
100% |
Administrative Claim Service |
27 |
23 |
85% |
0 |
0% |
4 |
100% |
Suffolk County Risk Management (NY) |
25 |
1 |
4% |
1 |
4% |
23 |
96% |
Constitution State Services LLC |
23 |
0 |
0% |
2 |
9% |
21 |
91% |
Oryx Insurance Brokerage, Inc. |
22 |
20 |
91% |
0 |
0% |
2 |
100% |
Wegmans Food Markets, Inc. |
22 |
0 |
0% |
3 |
14% |
19 |
86% |
Strategic Comp |
21 |
9 |
43% |
0 |
0% |
12 |
100% |
Hanover Insurance Company |
18 |
5 |
28% |
10 |
77% |
3 |
23% |
Dollar General |
17 |
1 |
6% |
0 |
0% |
16 |
100% |
CareWorks Network |
16 |
4 |
25% |
0 |
0% |
12 |
100% |
Protective Insurance |
16 |
0 |
0% |
14 |
88% |
2 |
13% |
Acadia Insurance |
15 |
10 |
67% |
0 |
0% |
5 |
100% |
Church Mutual Insurance Company |
15 |
0 |
0% |
1 |
7% |
14 |
93% |
ProSight Specialty Insurance |
14 |
5 |
36% |
9 |
100% |
0 |
0% |
OccuSure Claims Services |
13 |
13 |
100% |
0 |
0% |
0 |
0% |
Markel First Comp Insurance |
13 |
6 |
46% |
0 |
0% |
7 |
100% |
Tokio Marine Management, Inc. |
12 |
0 |
0% |
1 |
8% |
11 |
92% |
Federated Services Insurance Company |
12 |
0 |
0% |
3 |
25% |
9 |
75% |
The Cincinnati Insurance Company |
12 |
3 |
25% |
0 |
0% |
9 |
100% |
Northeast Shared Services |
12 |
12 |
100% |
0 |
0% |
0 |
0% |
GuideOne Insurance |
12 |
0 |
0% |
5 |
42% |
7 |
58% |
Network Adjusters, Inc |
11 |
8 |
73% |
0 |
0% |
3 |
100% |
Core Specialty |
10 |
10 |
100% |
0 |
0% |
0 |
0% |
Berkley Environmental |
10 |
7 |
70% |
0 |
0% |
3 |
100% |
Cottingham & Butler Claims Services, Inc. |
10 |
0 |
0% |
6 |
60% |
4 |
40% |
The Zenith |
9 |
0 |
0% |
6 |
67% |
3 |
33% |
SafeCo Insurance |
9 |
0 |
0% |
0 |
0% |
9 |
100% |
Madison Oneida Herkimer Work Comp Consortium |
8 |
8 |
100% |
0 |
0% |
0 |
0% |
Ryder Services Corp |
8 |
0 |
0% |
3 |
38% |
5 |
63% |
Greater New York Mutual Insurance Company |
8 |
1 |
13% |
5 |
71% |
2 |
29% |
Chesterfield Services |
7 |
7 |
100% |
0 |
0% |
0 |
0% |
Department of Labor |
7 |
0 |
0% |
4 |
57% |
3 |
43% |
A.G. Risk Management Inc. |
7 |
2 |
29% |
1 |
20% |
4 |
80% |
Creative Risk Solutions |
7 |
0 |
0% |
2 |
29% |
5 |
71% |
Golub Corporation |
6 |
4 |
67% |
0 |
0% |
2 |
100% |
New York City Fire Department (NY) |
6 |
1 |
17% |
1 |
20% |
4 |
80% |
Merchants Insurance Group |
6 |
5 |
83% |
0 |
0% |
1 |
100% |
Rochester-Genesee Regional Transportation Authority (NY) |
6 |
6 |
100% |
0 |
0% |
0 |
0% |
North American Risk Services |
5 |
0 |
0% |
1 |
20% |
4 |
80% |
Vanliner Insurance Company |
5 |
3 |
60% |
0 |
0% |
2 |
100% |
Fire Districts of New York Mutual Insurance Company |
5 |
2 |
40% |
3 |
100% |
0 |
0% |
W.J. Cox Associates, Inc. |
5 |
2 |
40% |
3 |
100% |
0 |
0% |
Michigan Millers Insurance |
5 |
4 |
80% |
0 |
0% |
1 |
100% |
Ford Motors Workers' Compensation |
4 |
0 |
0% |
0 |
0% |
4 |
100% |
Republic Franklin Insurance |
4 |
0 |
0% |
0 |
0% |
4 |
100% |
Blue Star Claims Management |
4 |
3 |
75% |
0 |
0% |
1 |
100% |
Emerald Claims Management |
4 |
3 |
75% |
0 |
0% |
1 |
100% |
National Interstate Insurance |
4 |
3 |
75% |
0 |
0% |
1 |
100% |
Omaha National Group |
3 |
2 |
67% |
0 |
0% |
1 |
100% |
Transit General Insurance Company |
3 |
3 |
100% |
0 |
0% |
0 |
0% |
Insurance Company of the West |
3 |
0 |
0% |
0 |
0% |
3 |
100% |
Creative Comp Solutions Network |
3 |
3 |
100% |
0 |
0% |
0 |
0% |
Electrical Employers Self Insurance Safety Plan |
3 |
3 |
100% |
0 |
0% |
0 |
0% |
Optum Network |
3 |
0 |
0% |
0 |
0% |
3 |
100% |
Phoenix Processor LP |
3 |
3 |
100% |
0 |
0% |
0 |
0% |
Paradigm Management Services Network |
3 |
1 |
33% |
0 |
0% |
2 |
100% |
The Central Insurance Companies |
3 |
3 |
100% |
0 |
0% |
0 |
0% |
Allianz |
3 |
0 |
0% |
1 |
33% |
2 |
67% |
Claimsake |
3 |
2 |
67% |
0 |
0% |
1 |
100% |
Coventry DME Plus Network |
2 |
0 |
0% |
0 |
0% |
2 |
100% |
Transportation Claims, Inc. |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
OneCall Care Management Network |
2 |
0 |
0% |
0 |
0% |
2 |
100% |
Nationwide Insurance Companies |
2 |
0 |
0% |
0 |
0% |
2 |
100% |
Innovative Claims Strategies, LLC |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
Packard Claims Administration |
2 |
1 |
50% |
0 |
0% |
1 |
100% |
World Trade Center Health Program |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
Pie Insurance |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
Tribal First |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
Warren County (NY) |
2 |
2 |
100% |
0 |
0% |
0 |
0% |
Brentwood Services Administrators, Inc. |
1 |
0 |
0% |
0 |
0% |
1 |
100% |
Sage Adjusting, LLC |
1 |
0 |
0% |
1 |
100% |
0 |
0% |
Applied Risk Solutions LLC |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
Apricus Network |
1 |
0 |
0% |
0 |
0% |
1 |
100% |
Fairly Group |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
MTI America Network |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
American Equity Underwriters |
1 |
0 |
0% |
1 |
100% |
0 |
0% |
Claims Service Bureau of New York |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
Glacier Bay TPA, LLC |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
Service Insurance Companies |
1 |
0 |
0% |
1 |
100% |
0 |
0% |
Alaska National Insurance |
1 |
0 |
0% |
0 |
0% |
1 |
100% |
City of Mount Vernon Police Department (NY) |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
Lawley Insurance |
1 |
1 |
100% |
0 |
0% |
0 |
0% |
Nordstrom Workers' Compensation |
1 |
0 |
0% |
0 |
0% |
1 |
100% |
Totals |
37,007 |
5,535 |
15% |
11,409 |
31% |
20,063 |
64% |
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