New York State seal

November 18, 1991

SUBJECT: INSURANCE

WITHDRAWN

Circular Letter No. 19 (1991)

TO: ALL MOTOR VEHICLE SELF INSURERS AND INSURERS LICENSED TO WRITE MOTOR VEHICLE INSURANCE IN NEW YORK

RE: EIGHTEENTH AMENDMENT TO REGULATION NO. 83

There was a technical error in the original State Administrative Procedure Act (SAPA) filing: SAPA Form 4 was used, when SAPA Form 4A should have been used in order to promulgate the Eighteenth Amendment on an emergency basis and to propose the regulation on a permanent basis. Therefore, due to, this technical error in SAPA filing, the final adoption of the Eighteenth Amendment to Regulation No. 83, previously issued by this Department, on August 22, 1991 is ineffective. We are now repromulgating the Eighteenth Amendment to Regulation 83 and proposing it on a permanent basis using SAPA Form 4A.

The original Eighteenth Amendment, which accompanied SAPA Form 4, remains the same -- with just one set of changes relating to scheduled fees for psychology. These limited changes are mandated by the recent promulgation of a psychology fee schedule, effective September 1, 1991, by the Workers' Compensation Board. Part D is being repealed and replaced by a schedule that incorporates the unit values and codes contained in the Workers' Compensation psychology fee schedule. Please note that Workers' Compensation reporting and procedural requirements do not apply to No-Fault.

By repromulgating the Eighteenth Amendment to Regulation 83, utilizing SAPA Form 4A. the fee schedules embodied Mille original emergency filing remain in effect, without interruption, with revised Part D. The Insurance Department anticipates finally adopting this Eighteenth Amendment to Regulation No. 83 in January 1992, at the conclusion of the public comment period. Since the underlying Eighteenth Amendment is essentially the same as that previously issued, those that want another copy can obtain it from the Department by calling the No-Fault Administration Unit (212-602-0334). New Part D is attached to this Circular Letter for convenient reference.

Very Truly yours, [SIGNATURE]

ALVATORE R. CURIALE

SUPERINTENDENT OF INSURANCE

Part D. --[Clinical] Psychological [Services]Fee Schedule

The maximum permissible charge for any clinical psychological service is the product of the unit value shown in the following schedule and the regional conversion factor, [set forth on the following page.]

[Clinical] Psychological Services

 

UNIT VALUE [Therapy individual] or family;

verbal or other method, per session:

 

   50 minutes (prorated); office or hospital

16.0

   home

17.5

   

Biofeedback session:

 

   50 minutes (prorated)

 

See Code numbers 90900 through 90911 in the Workers'

 

Compensation Medical fee Schedule for the unit value

 

for the procedure performed. The regional conversion

 

factor is the appropriate factor on the following page.

 
   

Group (maximum of 8 persons per group),

 

one and one-half hours (prorated) per

 

person, per session; 45-50 minutes

4.0

   90 minutes

6.4

   

Psychological testing or related tests, by or

 

under the supervision of psychologist,

 

with written report, per hour (prorated)

18.5

   

Inpatient care, including supervision of milieu:

 

   50 minutes (prorated)

18.5

   

Consultation with other health professionals:

 

   50 minutes [(prorated)

13.0]

Psychological services will be rendered by or under the active and personal supervision of an authorized psychologist. The scope of these psychological services will conform to the training, qualification and experience requirements mandated and specified under the New York State Education Law.

PS90803

Psychotherapy, individual adult or child, 45-50 minutes

 
     

office or outpatient

16.0

 

hospital service

   

PS90805

Home

17.5

PS90806

25 minutes, office or outpatient hospital service

9.7

PS90808

Home

10.0

PS90811

15 minutes, office or outpatient hospital service

6.4

PS90813

Home

7.3

PS90815

Group therapy - per person, per session - 45-50 minutes,

 
 

office

4.0

PS90816

90 minutes, office

6.4

PS90840

Psychological evaluation, including clinical interviews,

 
 

standardized tests, analysis interpretation and

 
 

follow-up consultation with patient per treatment hour.

 
 

Written report required identifying evaluation procedures

 
 

used specifying the duration of each category. (Written

 
 

report is not a billable item)

18.5

PS90890

Inpatient care, which may include psychotherapy,

 
 

supervision of milieu/case management: 45 minutes (prorated)

18.5

PS90891

Consultation with other health professionals

13.0

Biofeedback session:

Administration of biofeedback treatment is limited to licensed psychologists. Biofeedback treatments may be administered for the following conditions:

(a) Idiopathic Raynaud's disease

(b) Temporomandibular loint Dysfunction

(c) Myofascial Pain Dysfunction Syndrome (MPD)

(d) Tension headaches

(e) MigLaingheadaches

(f) Tinnitus

(g) Torticollis

(h) Neuromuscular re-education as a result of neurological damage in CVA or spinal cord injury

(i) inflammatory and/or musculoskeletal disorders causally related to the accepted condition.

(j) Psychological diagnosis appropriate in the judgement of the psychologist.

Biofeedback treatments may be allowed for the above conditions when the following is presented:

(a) An evaluation report documenting:

(i) The basis for the claimant's condition;

(ii) The condition's relationship to the automobile accident;

(iii) An evaluation of the claimant's current functional leasurable modalities (i.e., range of motion, up time, walking tolerance, medication intake etc.);

(iv) An outline of the proposed treatment program:

(v) An outline of the expected restoration goals.

(b) Further Biofeedback treatments will be paid with substantiation of evidence of improvement in measurable functional modalities etc. The fees include interpretations and revorts of the treatments. When more than one of the treatment are performed in the same day, the maximum payment will be limited to 48.0 units.

   

UNIT VALUE

PS90900

Biofeedback training by electromyogram application -

 
 

separate procedure (one-half hour)

5.0

PS90901

Biofeedback training, by electromyogram application. -

 
 

including office visit (one hour)

8.0

PS90902

In conduction disorder separate procedure

 
 

(one-half hour)

5.0

PS90903

In conduction disorder-including office visit

 
 

(one hour)

8.0

PS90904

Regulation of blood pressure-separate procedure (one

 
 

half hour

5.0

PS90905

Regulation of blood pressure. including office visit

 
 

(one hour)

8.0

PS90906

Regulation of skin-temperatlire or peripheral blood

 
 

flow-separate procedure (one-half hour)

5.0

PS90907

Regulation of skin temperature or peripheral blood

 
 

flow, including office visit (one hour)

8.0

PS90908

By electroencephalogram application - separate

 
 

procedure (one-half hour)

5.0

PS90909

By electroencephalogram application, including office

 
 

visit (one hour)

8.0

PS90910

By electro-oculogram application, separate procedure

 
 

(one-half hour).

5.0

PS90911

By electro-oculogram application, including office

 
 

visit (one hour)

8.0

PART D

REGIONAL CONVERSION FACTORS

EFFECTIVE SEPTEMBER 1, [1990] 1991

REGION*

REGIONAL

 

CONVERSION FACTOR

I

[4.54]4.55

II

[4.76]4.15

III

[5.45]5.44

IV

[5.91]5.90

* Region determined by

provider's zip code.

See Amendment 18 to

Appendix 17-C for Table

of Zip Codes.