New York State Department of Financial Services

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11 NYCRR 68

 PART 68 – CHARGES FOR PROFESSIONAL HEALTH SERVICES

(Regulation 83)

 

  • Section 68.0    Preamble.
  • Section 68.1    Adoption of certain Workers' Compensation schedules.
  • Section 68.2    Establishment of certain health provider schedules.
  • Section 68.3    Applicability of limitations.
  • Section 68.4    Exception to limitations.
  • Section 68.5    Health services not set forth in schedules.
  • Section 68.6    Health services performed outside New York State.
  • Section 68.7    Restriction on health provider charges.
  • Section 68.8    Insurers' reports relating to health providers.
  • Section 68.9    Health services provided through a managed care organization.
  • Appendix 17-C     Fee Schedules for Professional Health Services not established by the Workers' Compensation Board.
  • Appendix 17-D     Schedule of rates for Outpatient Hospital Services (1/1/1985 - 12/31/1985).
  • § 68.0Preamble

    (a)Chapter 892 of the Laws of 1977 provides, as a means of containing the cost of no-fault insurance, for the establishment of schedules of maximum permissible charges for medical, hospital and other professional health services payable under no-fault insurance benefits. Specifically, section 5108(a) of the Insurance Law provides that the charges for services specified in section 5102(a)(1) of the Insurance Law, and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, "... shall not exceed the charges permissible under the schedules prepared and established by the chairman of the Workers' Compensation Board for industrial accidents, except as otherwise provided in section thirteen-a of the Workers' Compensation Law."

    (b)Paragraph (1) of subdivision (a) of section 5102 of the Insurance Law defines basic economic loss to include necessary expenses incurred for (i) medical, hospital, surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services; (ii) psychiatric, physical and occupational therapy and rehabilitation; (iii) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of this State; and (iv) any other professional health services.

    (c)Section 5102(a) of the Insurance Law provides that for the purpose of determining basic economic loss, the expenses incurred under section 5102(a)(1) shall be in accordance with the limitations of section 5108 of the Insurance Law.

    (d)The Superintendent of Financial Services is required, after consulting with the chairman of the Workers' Compensation Board and the Commissioner of Health, to promulgate rules and regulations implementing and coordinating the Comprehensive Automobile Insurance Reparations Act and the Workers' Compensation Law regarding the charges for other professional health services, including the establishment of schedules for all such services for which schedules have not been prepared and established by the chairman of the Workers' Compensation Board.

    (e)The chairman of the Workers' Compensation Board has to date prepared and established fee schedules for medical, chiropractic and podiatric services. These schedules also include fees for some dental, psychiatric and physical therapy services.

    (f)Providers of health services are prohibited from demanding or requesting any payment for services in excess of permissible charges, and the law requires insurers to report to the Commissioner of Health patterns of overcharging, excessive treatment or other improper actions by a health provider.

    § 68.1Adoption of certain workers' compensation schedules

    (a)The existing fee schedules prepared and established by the chairman of the Workers' Compensation Board for industrial accidents are hereby adopted by the Superintendent of Financial Services with appropriate modification so as to adapt such schedules for use pursuant to the provisions of section 5108 of the Insurance Law.

    (b)

    (1) The charges for services specified in paragraph one of subsection (a) of section 5102 of the Insurance Law and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, shall not exceed the charges permissible under the schedules prepared and established by the chair of the Workers' Compensation Board for industrial accidents. However, references to workers' compensation reporting and procedural requirements in such schedules do not apply, e.g., requirements that provide for authorization to perform surgical procedures, is not applicable to no-fault. The general instructions and ground rules in the workers' compensation fee schedules apply, but those rules which refer to workers' compensation claim forms, pre-authorization approval and dispute resolution guidelines do not apply, unless specified in this Part.

    (2) If a fee schedule has been adopted for a licensed health provider, the fee for services provided shall be the fee adopted or established for that licensed health provider (for example, the fee for chiropractic services performed by a chiropractor employed by a physician would be the fee applicable for chiropractic services as contained in the Chiropractic Fee Schedule). However, if the Workers' Compensation Fee Schedule contains a specific ground rule to permit reimbursement at the physician rate then that rule will apply. (For example, the fee for services performed by a physical or occupational therapist employed by a physician would be the fee applicable at the physician rate in accordance with Ground Rule Nine contained in the Workers' Compensation Physical Medicine Fee Schedule).

    (3) A "licensed health provider" means a licensed healthcare professional acting within the scope of his or her licensure or an entity, including a pharmacy properly formed in accordance with applicable law and acting within the scope of its license.

    § 68.2Establishment of certain health provider schedules

    (a)After consultation with the chairman of the Workers' Compensation Board and the Commissioner of Health, the Superintendent of Financial Services hereby establishes fee schedules for professional health services referred to in section 5102(a)(1) of the Insurance Law, and for which schedules have not been prepared and established by the chairman of the Workers' Compensation Board. The schedules for such professional health services, hereby adopted by the Superintendent of Financial Services, are incorporated herein as Appendix 17-C and charges for services listed therein shall not exceed the charges permissible under such schedules.

    (b)The fee schedules established by the superintendent for professional services referred to in section 5102(a)(1) of the Insurance Law are hereby amended as set forth in Amendment 23 to Appendix 17-C.  Charges for the services listed in the fee schedules, as amended, shall not exceed the charges permissible under such schedules and shall apply to charges for services performed on or after September 1, 1994.

    § 68.3Applicability of limitations

    The limitations set forth in this Part for charges by providers of health services apply to all services specified in section 5102(a)(1) of the Insurance Law, and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss. Such limitations shall apply to all health services performed on or after December 1, 1977 with respect to any personal injury arising from the use and operation of a motor vehicle on or after December 1, 1977. Charges for health services performed on or after December 1, 1977 as a result of personal injury due to the use and operation of a motor vehicle prior to such date are not, by statute, subject to the limitations of this Part.

    § 68.4Exception to limitations

    A charge in excess of the scheduled fee may be authorized by the insurer, the arbitrator of disputes involving health services or a court of competent jurisdiction, if such insurer, arbitrator or court finds that an unusual procedure or unique circumstance justifies the necessity for such charge. This exception to the fee schedule limitations shall not apply to charges for hospital inpatient services subject to a per diem rate in the hospital fee schedule.

    § 68.5Health services not set forth in schedules

    If a professional health service is performed which is reimbursable under section 5102(a)(1) of the Insurance Law, but is not set forth in fee schedules adopted or established by the superintendent, and:

    (a)if the superintendent has adopted or established a fee schedule applicable to the provider, then the provider shall establish a fee or unit value consistent with other fees or unit values for comparable procedures shown in such schedule, subject to review by the insurer; or

    (b)if the superintendent has not adopted or established a fee schedule applicable to the provider, then the permissible charge for such service shall be the prevailing fee in the geographic location of the provider subject to review by the insurer for consistency with charges permissible for similar procedures under schedules already adopted or established by the superintendent.

    § 68.6Health services performed outside New York State

    If a professional health service reimbursable under section 5102(a)(1) of the Insurance Law is performed outside New York State, the permissible charge for such service shall be the prevailing fee in the geographic location of the provider.

    § 68.7Restriction on health provider charges

    (a)No provider of health services specified in section 5102(a)(1) of the Insurance Law may demand or request any payment in addition to the charges permitted by the provisions of this Part. If the insured also possesses health insurance coverage and such health insurance contract does not exclude payment for no-fault benefits, payment by the health insurer for health services under such contract is restricted by the limitations of section 5108 of the Insurance Law, unless such limitation would impair the terms of a provider's contract with the health insurer, in which case payment by the health insurer to the provider may be made in accordance with the provider's contract; however, the provider may not receive duplicate payment.

    (b)If coverage for health services specified in section 5102(a)(1) of the Insurance Law is provided pursuant to section 5103(g) of the Insurance Law, charges for such health services are restricted by the limitation of section 5108 of the Insurance Law.

    (c)This subdivision is applicable to accidents that occurred between December 1, 1977 and December 5, 1980, regardless of the date service was rendered; and to services rendered prior to June 6, 1983 for accidents that occurred on or after December 5, 1980. If a health service provider accepts an assignment of an eligible injured person's Medicare benefits, the provider, for purposes of this Part, is deemed to have contracted with the Social Security Administration. Reimbursement for services rendered to a patient eligible for both No-Fault and Medicare is illustrated by the following example: assume a procedure where a physician's usual and customary charge is $ 50, the Medicare allowable charge is $ 40 and the No-Fault fee schedule amount is $  30:

    (1) If the physician takes a Medicare assignment:

    (i) Medicare would pay $ 32 (80%);

    (ii) No-Fault should be billed $ 8 (20%);

    (iii) the No-Fault insurer would be responsible for the amount credited by Medicare to the patient's deductible; and

    (iv) physicians should bill Medicare first in the manner they customarily would have billed prior to December 1, 1977.

    (2) If the physician does not take Medicare assignments, no contract exists with Medicare, therefore the Insurance Law, section 5108 limitations apply:

    (i) Medicare must be billed $ 30 (No-Fault allowance), of which $ 24 (80%) will be paid the physician;

    (ii) No-Fault should be billed $ 6 (20%); and

    (iii) the No-Fault insurer would be responsible for the amount credited by Medicare to the patient's deductible.

    § 68.8Insurers' reports relating to health providers

    (a)Insurers shall report any pattern of overcharging, excessive treatment or any other improper actions by a health provider, within 30 days after such insurer has knowledge of such pattern to the No-Fault Unit, Property Bureau, New York State Department of Financial Services, One State Street, New York, NY 10004, and to the following:

    (1) Complaints about:

    (i) Physicians and physicians' assistants.

    (a) Services rendered in New York City:

    Supervising Investigator

    Office of Professional Medical Conduct

    New York State Department of Health

    5 Penn Plaza

    New York, NY 10001

    (b) Services rendered in remainder of State:

    Director

    Office of Professional Medical Conduct

    New York State Department of Health

    433 River Street, Suite 303

    Troy, NY 12180-2299

    (ii) Hospitals.

    Deputy Director

    Division of Health Care Financing

    New York State Office of Health Systems Management

    Corning Tower

    Empire State Plaza

    Albany, NY 12237

    (iii) Other health providers.

    Director

    Office of Professional Discipline

    New York State Education Department

    475 Park Avenue South

    New York, NY 10016

    (b)A pattern of overcharging, excessive treatment or any other improper actions is present when such actions involve three or more patients. In determining whether a pattern of overcharging exists, insurers shall not consider as overcharging any charge which is based upon:

    (1) a "BR" or "by special agreement" unit value listing in the medical fee schedule;

    (2) the presence of unique circumstances or the performance of an unusual procedure, as authorized by section 68.5 of this Part; or

    (3) the provider's determination of an appropriate fee consistent with permissible charges for comparable or similar procedures, as authorized by section 68.6 of this Part.

    Insurers must designate a claims person in each no-fault claim processing office to maintain a master file of each instance of overcharging, excessive treatment or any other improper action on the part of a health service provider. Notwithstanding the above, insurers shall report any known instance where the claimant has paid the provider the difference between the provider's charge and the maximum allowable fee or where the provider has charged for treatment not rendered.

    (c)Reports alleging a pattern of overcharging shall be subject to a hearing by the department in accordance with Part 4 of this Title.

    § 68.9Health services provided through a managed care organization

    (a)Notwithstanding any other provision of this Part, a health care provider participating in a certified managed care organization pursuant to an approved managed care program, in accordance with Section 5109 of the Insurance Law, may accept a fee, or agree to bundle services for fees, different than the fees prescribed in this Part, provided that costs for medical and other health care services provided by managed care organizations for an insurer's managed care program shall not, in the aggregate, exceed the costs that would be otherwise payable by application or the fee schedules established by the superintendent or the Chair of the Workers' Compensation Board.

    (b)No insurer subject to this Part shall contract with a managed care organization on a capitation basis, unless the managed care organization is:

    (1) a health maintenance organization issued a certificate of authority under article 44 of the Public Health Law or licensed under article 43 of the Insurance Law; or

    (2) an insurer (including an article 43 corporation) licensed to write accident and health insurance pursuant to the Insurance Law.

    .

    Appendix 17C

    (cf. §  68.3) Introduction. Regional conversion factors are used in the Workers' Compensation medical fee schedule to recognize differences in the cost of conducting a medical practice in various geographic regions of the State. Regional conversion factors were developed after a study was made by the chair of the Workers' Compensation Board.

    The components considered in the study made by the chair of the Workers' Compensation Board relative to the cost of conducting a medical practice generally apply to dentists, social workers, speech therapists and optometrists and, while there may be differences in some components, it has been determined by the superintendent that the percentage difference in relative cost by region applicable to physicians is also applicable to the cost of conducting a dental, social worker, speech therapy, optometric practice and by a thermographic technician. This determination will maintain consistency between the schedules established by the chair of the Workers' Compensation Board and specified schedules established by the superintendent under section 5108 of the New York Insurance Law. Regional conversion factors are listed in Parts A, C, D, I and L of this Appendix. For this purpose there are established four regions, based on the differences in the cost of maintaining various health provider practices in different localities of the State. The regions defined in Appendix 17-A of this Title, using United States Postal Service ZIP codes for the State of New York, are hereby adopted as being applicable to Parts A, C, D, I and L of this Appendix.

    The fee payable for care and treatment rendered by health care providers in accordance with Parts A, C, D, I and L of this Appendix shall be determined by the region in which the services were rendered. There are hereby established for each region the following regional conversion factors for the indicated Parts of this Appendix:

    REGIONAL CONVERSION FACTORS

    Region I Region II Region III Region IV
    A (Dental) 22.62 23.70 27.12 29.47
    C (Social workers) 3.47 3.64 4.16 4.52
    D (Therapy) 6.22 6.51 7.45 8.10
    I (Eye exams) 15.89 16.65 19.05 20.70
    L (Thermography)
    -Medical Doctor 44.55 46.67 53.41 58.04
    -Dentist 44.55 46.67 53.41 58.04
    -Chiropractic Doctor 42.33 44.35 50.75 55.14

    To determine the maximum allowable fee for a procedure, it is necessary to multiply the unit value by the conversion factor. Example: If the dental procedure designated as procedure 02510 in the dental fee schedule is performed in Region II, the maximum allowable fee is determined by multiplying the unit value, 8.5, by 23.70, the dental conversion factor, i.e., 8.5 x 23.70 = 201.45.

    POSTAL ZIP CODES INCLUDED IN EACH REGION

    Region I
    From Thru
    12007

    ........................................................... 12099
    12106 ........................................................... 12177
    12184 ........................................................... 12199
    12401 ........................................................... 12498
    12701 ........................................................... 12792
    12801 ........................................................... 12887
    12901 ........................................................... 12998
    13020 ........................................................... 13094
    13101 ........................................................... 13167
    13301 ........................................................... 13368
    13401 ........................................................... 13439
    13441 ........................................................... 13495
    13601 ........................................................... 13698
    13730 ........................................................... 13797
    13801 ........................................................... 13865
    14001 ........................................................... 14098
    14101 ........................................................... 14174
    14301 ........................................................... 14305
    14410 ........................................................... 14489
    14501 ........................................................... 14592
    14701 ........................................................... 14788
    14801 ........................................................... 14898
    14901 ........................................................... 14905

     

    Region II
    From Thru
    12180 ........................................................... 12183
    12201 ........................................................... 12257
    12301 ........................................................... 12345
    12501 ........................................................... 12594
    12601 ........................................................... 12614
    13201 ........................................................... 13260
    13440 ........................................................... --
    13501 ........................................................... 13503
    13901 ........................................................... 13905
    14201 ........................................................... 14265
    14601 ........................................................... 14692

     

    Region III
    10501 ........................................................... 10598
    10601 ........................................................... 10650
    10701 ........................................................... 10710
    10801 ........................................................... 10805
    10901 ........................................................... 10998
    11901 ........................................................... 11980
    ...........................................................

     

    Region IV
    From Thru
    10001 ........................................................... 10099
    10301 ........................................................... 10314
    10401 ........................................................... 10475
    11001 ........................................................... 11050
    11101 ........................................................... 11111
    11201 ........................................................... 11252
    11301 ........................................................... 11390
    11401 ........................................................... 11460
    11501 ........................................................... 11598
    11601 ........................................................... 11697
    11701 ........................................................... 11798
    11801 ........................................................... 11819

     

    NUMERICAL LIST OF POSTAL ZIP CODES

    From Thru Region From Thru Region
    10001 10099 IV 12601 12614 II
    10301 10314 IV 12701 12792 I
    10401 10475 IV 12801 12887 I
    10501 10598 III 12901 12998 I
    10601 10650 III 13020 13094 I
    10701 10710 III 13101 13167 I
    10801 10805 III 13201 13260 II
    10901 10998 III 13301 13368 I
    11001 11050 IV 13401 13439 I
    11101 11111 IV 13440 --- II
    11201 11252 IV 13441 13495 I
    11301 11390 IV 13501 13503 II
    11401 11460 IV 13601 13698 I
    11501 11598 IV 13730 13797 I
    11601 11697 IV 13801 13865 I
    11701 11798 IV 13901 13905 II
    11801 11819 IV 14001 14098 I
    11901 11980 III 14101 14174 I
    12007 12099 I 14201 14265 II
    12106 12177 I 14301 14305 I
    12180 12183 II 14410 14489 I
    12184 12199 I 14501 14592 I
    12201 12257 II 14601 14692 II
    12301 12345 II 14701 14788 I
    12401 12498 I 14801 14898 I
    12501 12594 II 14901 14905 I

     

    Part A.Reserved

    Part B.Private nursing services fee schedules.

    (a)Registered professional nurses. The maximum permissible charge for private nursing services is the local prevailing charge for such services.

    (b)Licensed practical nurses. The maximum permissible charge for private nursing services is the local prevailing charge for such services.

    Part C.Psychiatric social worker fee schedule.

    The maximum permissible charge for any duly licensed psychiatric social worker's services is the product of the unit value shown in the following schedule and the regional conversion factor set forth in this Part. For psychiatric services performed by a physician, see the Workers' Compensation medical fee schedule.

    Psychiatric social worker services Unit Value
    Office visit, 50 minutes (prorated) 16.0
    Home visit, 50 minutes (prorated) 17.5
    Group therapy, per recipient (maximum 8 persons per group)

    45-50 minutes, office

    4.0

    90 minutes, office

    6.4

    PART C

    REGIONAL CONVERSION FACTORS(Effective September 1, 1994)

    Regional

    Region[1] conversion factor
    I $ 3.47
    II $ 3.84
    III $ 4.16
    IV $ 4.52

    Psychological fee schedule.

    Please refer to the Workers' Compensation psychology fee schedules.

    [1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

    Part D.Speech therapy fee schedule.

    The maximum permissible charge for any services performed by a qualified speech therapist is the product of the unit value shown in the following schedule and the regional conversation factor set forth in this Part.  For physical and occupational therapy, see the Workers' Compensations medical fee schedule.

    Therapy services   Unit value
    1. Therapy sessions at a clinic, hospital outpatient department or therapist's office:
    Individual therapy session: 30 minutes or less 4.70
      more than 30 minutes 6.40
    Group therapy session, per patient 90 minutes or less 6.42
    Group of two: more than 90 minutes  8.74
    Group of three: 90 minutes or less 4.70
      more than 90 minutes 6.40
    Group of four: 90 minutes or less 3.75
      more than 90 minutes 5.11

    2. Comprehensive evaluation and written report by a speech pathologist                 9.8

    PART D

    REGIONAL CONVERSION FACTORS         (Effective September 1, 1994)

    Regional

    Region[1] conversion factor
    I $ 6.22
    II $ 6.51
    III $ 7.45
    IV $ 8.10

    [1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

    Part E.Reserved

    Part F.Reserved

    Part G.Ambulance and other common carrier transportation.

    (a)        The maximum permissible charge for ambulance service is the local prevailing charge for such service.

    (b)        The maximum permissible charge for other common carrier transportation is the local prevailing charge for such service, based on the most direct route.

    Part H.Hearing aid supplies and services.

    The maximum permissible charge for hearing aid supplies and services is the actual cost of the hearing aid to the provider, plus:

    (a)        in the case of a monaural instrument, a dispensing fee of $ 266;

    (b)        in the case of a binaural instrument, a dispensing fee of $ 344.

    Part I.              Eye examinations and related services fee schedule.

    The maximum permissible charge for eye examinations or related services performed by an optometrist is the product of the unit value shown in the following schedule and the regional conversion factor set forth below:

    Optometric services Unit value
       
    Eye examination, with refraction and prescription for glasses, if required 2.32
    Clinical services:  

    One-hour session:

    3.63

    Two-hour session:

    5.77

    (for eye examinations and other professional services performed by an ophthalmologist, see the section labeled Ophthalmological Diagnostic and Treatment Services, starting with Code 92002 in the Workers' Compensation medical fee schedule.)

    PART I

    REGIONAL CONVERSION FACTORS (Effective September 1, 1994)

    Regional

    Region[1] conversion factor
    I $ 15.89
    II $ 16.65
    III $ 19.05
    IV $ 20.70

    [1]        Region determined by provider's ZIP code. See table of ZIP codes set forth in the Numerical List of Postal Zip Codes contained in the Introduction to Appendix 17-C.

    Part J.             Eyeglasses fee schedule.

    (a)        The maximum permissible charge for providing and fitting eyeglasses shall be equal to the sum of:

    (1) the actual cost of the frames to the provider, not to exceed $ 27.00+, plus a dispensing fee of $ 28.00; and

    (2) a charge for obtaining and dispensing lenses, not to exceed $ 51.00 for single vision lenses, $ 82.00 for bifocal lenses, and $ 97.00 for trifocal lenses.

    (b)        The maximum permissible charge for providing contact lenses, including dispensing fee, shall be:

    (1) hard contact lenses-$ 148.00; and

    (2) soft contact lenses-$ 246.00

    +          This limitation shall not apply when the frames are identical to or substantially the same design and cost as frames damaged, lost, or otherwise requiring  replacement as a result of an automobile accident; in such case, the maximum permissible charge is the actual cost of the frames to the provider, plus a $ 28.00 dispensing fee.

    Part K.             Fee schedule for services rendered in accordance with a religious method of healing.

    The maximum permissible charge for nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of the State of New York, by a practitioner accredited to provide such care and treatment is $ 27.00 per day.

    .

    Appendix 17D (cf. Part 68)

    SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL SERVICES

    Effective 1/1/85 - 12/31/85

    Room other than an operating room when used for minor surgery or emergency treatment:

    For the medical service provided, whether by employed staff, attending staff or by contractual arrangement with the physician groups, the fee for this service is the fee as appears on line 90010 of the Schedule of Medical Fees.

    For the hospital providing intern or resident staffing or by physician group contractual coverage, the total fee is the fee for physician services as appears on line 90010 of the Schedule of Medical Fees plus the fee for use of the Emergency Service Room as set forth below.

    When the care is provided by an attending physician, the hospital fee is the Emergency Service Room fee as set forth below, with the physician billing separately. Note: The above fees include common or ordinary medications.

    Crutches, mechanical splints and appliances                       Rental or sale at cost

    Plaster cast and/or splint                                                        Cost of plaster

    Radium and deep therapy                                                      A & A (authorization and arrangement)

    E.K.G., E.E.G., X-RAY, P.T. and laboratory charges Rates in Schedule of Medical Fees

                                                                                                    promulgated by the Chairman,

                                                                                                    Workers' Compensation Board

    Material supplied by the emergency room (i.e., sterile trays, medications, etc.) over and above those usually included with the emergency room visit may be charged for separately. Itemize these on the bill submitted.

    COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES

    A study was undertaken to determine the low-cost drugs which a large number of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive emergency room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list, or heretofore regarded as common or ordinary, or any additional drugs so regarded, should be considered as covered by the applicable emergency room rate.

    No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients. Current List of "No Charge" Drugs and Pharmaceutical Supplies

    Acetaminophen 325 mg tablet Lidocaine 2 percent with/without Epinephrine
    Alcohol 70 percent Lidocaine 5 percent ointment
    Alcohol swabs Lindane lotion (e.g., Kwell)
    Antacid (e.g., Mylanta, Maalox, etc.) Lubricating jelly
    Aspirin 325 mg tablet Magnesium Sulfate
    Aromatic spirits of ammonia Meperidine injection (e.g., Demerol)
    Atropine 2 percent ophthalmic solution Merthiolate
    Atropine 0.4 mg/ml Neomycin and Polymyxin B Sulfates w/ Hydrocortisone ophthalmic suspension (e.g., Cortisporin)
    Bacitracin ointment Nitroglycerin 0.4 mg s.1. tablet
    Castor oil Nitroglycerin 0.6 mg s.1. tablet
    Calamine lotion Peppermint Spirit
    Collodion flexible Petrolatum
    Cold cream Providone-Iodine solution (e.g., Betadine)
    Clinitest tablets Pralidoxime Chloride (e.g., Protopam)
    Dibucaine 1 percent ointment (e.g., Nupercainal) Silver Nitrate sticks
    Epinephrine injection Silver Sulfadiazine cream (e.g., Silvadene)
    Ethyl Chloride spray Sodium Chloride - injection
    Gelfoam Sodium Chloride for irrigation
    Glycerin suppository Sterile water for irrigation
    Hematest tablets Talcum powder
    Hydrocortisone 1 percent ointment Tetanus Toxoid
    Hydrogen Peroxide Tuberculin PPD (1st and 2nd strength)
    Iodine Witch Hazel
    Ipecac syrup Zinc Oxide ointment
    Lidocaine 2 percent viscous (e.g., Xylocaine)  
    Lidocaine 1 percent with/without Epinephrine  

    Emergency service room rate No-Fault -- effective 01/01/85 - 12/31/85

    Hospital

    Western New York Region

    ALLEGANY:

    Cuba Memorial Hospital, Inc. $ 30
    Memorial Hospital of Wm. F. & Gertrude F. Jones Memorial A/K/A Jones Memorial $ 30

    CATTARAUGUS:

    Olean General Hospital $ 37
    Salamanca Hospital District Authority $ 28
    St. Francis Hospital of Olean $ 30
    Tri-County Memorial Hospital $ 30

    CHAUTAUQUA:

    Brooks Memorial Hospital $ 30
    Jamestown General Hospital $ 48
    Lake Shore Hospital, Inc. $ 30
    Westfield Memorial Hospital, Inc. $ 48
    Woman's Christian Association $ 30

    ERIE:

    Bertrand Chaffee Hospital $ 28
    Buffalo Columbus Hospital $ 28
    Buffalo General Hospital $ 48
    Children's Hospital of Buffalo $ 30
    Erie County Medical Center $ 48
    Kenmore Mercy Hospital $ 37
    Lafayette General Hospital $ 37
    Mercy Hospital of Buffalo $ 28
    Millard Fillmore Hospital $ 37
    Our Lady of Victory Hospital of Lackawanna $ 48
    Roswell Park Memorial Institute No E.R. service
    Saint Francis Hospital of Buffalo $ 48
    Sheehan Memorial Emergency Hospital, Inc. $ 28
    Sheridan Park Hospital, Inc. $ 37
    Sisters of Charity Hospital $ 48
    St. Joseph Intercommunity Hospital $ 37

    GENESEE:

    Genesee Memorial Hospital $ 30
    St. Jerome Hospital $ 30

    NIAGARA:

    Degraff Memorial Hospital $ 30
    Inter-Community Memorial Hospital at Newfane, Inc. $ 30
    Lockport Memorial Hospital $ 48
    Mount St. Mary's Hospital of Niagara Falls $ 37
    Niagara Falls Memorial Medical Center $ 37

    ORLEANS:

    Arnold Gregory Memorial Hospital $ 28
    Medina Memorial Hospital $ 30

    WYOMING:

    Wyoming County Community Hospital $ 48

    CHEMUNG:

    Arnot-Ogden Memorial Hospital $ 37
    St. Joseph's Hospital of Elmira $ 48

    LIVINGSTON:

    Nicholas H. Noyes Memorial Hospital $ 37

    MONROE:

    Genesee Hospital of Rochester $ 48
    Highland Hospital of Rochester $ 48
    Lakeside Memorial Hospital $ 37
    Monroe Community Hospital No E.R. service
    Park Ridge Hospital $ 48
    Rochester General Hospital $ 48
    St. Mary's Hospital of Rochester $ 48
    Strong Memorial Hospital $ 48

    ONTARIO:

    Clifton Springs Hospital and Clinic

    $ 48

    F.F. Thompson Hospital

    $ 30

    Geneva General Hospital

    $ 37

    SCHUYLER:

    Schuyler Hospital

    $ 28

    SENECA:

    Seneca Falls Hospital

    $ 48

    Waterloo Memorial Hospital, Inc. d/b/a Taylor-Brown Memorial Hospital

    $ 48

    STEUBEN:

    Bethesda Hospital

    $ 28

    Corning Hospital

    $ 48

    Ira Davenport Memorial Hospital, Inc.

    $ 48

    St. James' Mercy Hospital

    $ 30

    WAYNE:

    Myers Community Hospital Foundation, Inc.

    $ 37

    Newark-Wayne Community Hospital, Inc.

    $ 37

    YATES:

    Soldiers and Sailors Memorial Hospital of Yates County, Inc.

    $ 37

    Central New York Region

    BROOME:

    Our Lady of Lourdes Memorial Hospital

    $ 37

    United Health Services, Inc.

    $ 37

    CAYUGA:

    Auburn Memorial Hospital

    $ 30

    CHENANGO:

    Chenango Memorial Hospital, Inc.

    $ 37

    CORTLAND:

    Cortland Memorial Hospital, Inc.

    $ 37

    HERKIMER:

    Little Falls Hospital

    $ 30

    Mohawk Valley General Hospital

    $ 28

    JEFFERSON:

    Carthage Area Hospital, Inc.

    $ 37

    Edward John Noble Hospital of Alexandria Bay

    $ 37

    House of the Good Samaritan

    $ 30

    Mercy Hospital of Watertown

    $ 37

    LEWIS:

    Lewis County General Hospital

    $ 48

    MADISON:

    Community Memorial Hospital, Inc.

    $ 37

    Oneida City Hospital

    $ 28

    ONEIDA:

    Children's Hospital and Rehabilitation Center

    No E.R. service

    Faxton Hospital

    $ 28

    Rome Hospital and Murphy Memorial Hospital

    $ 30

    St. Elizabeth Hospital

    $ 48

    St. Luke's Memorial Hospital Center

    $ 30

    ONONDAGA:

    Community General Hospital of Greater Syracuse

    $ 48

    Crouse Irving Memorial Hospital

    $ 48

    St. Joseph's Hospital Health Center

    $ 30

    State University Hospital--Upstate Medical Center

    $ 48

    OSWEGO:

    Albert Lindley Lee Memorial Hospital

    $ 30

    Oswego Hospital

    $ 30

    ST. LAWRENCE:

    A. Barton Hepburn Hospital

    $ 37

    Canton-Potsdam Hospital

    $ 30

    Clifton-Fine Hospital

    $ 28

    Edward John Noble Hospital of Gouverneur

    $ 30

    Massena Memorial Hospital

    $ 37

    TIOGA:

    Tioga General Hospital

    $ 30

    TOMPKINS:

    Tompkins County Hospital

    $ 30

    Northeastern New York Region

    ALBANY:

    Albany Medical Center Hospital

    $ 48

    Child's Hospital

    No E.R. service

    Cohoes Memorial Hospital

    $ 37

    Memorial Hospital of Albany

    $ 30

    St. Peter's Hospital

    $ 48

    CLINTON:

    Champlain Valley Physicians Hospital Medical Center

    $ 30

    COLUMBIA:

    Columbia Memorial Hospital

    $ 37

    DELAWARE:

    A. Lindsay & Olive B. O'Connor Hospital

    $ 30

    Community Hospital of Stamford

    $ 30

    Delaware Valley Hospital, Inc.

    $ 28

    Margaretville Memorial Hospital

    $ 30

    The Hospital

    $ 30

    ESSEX:

    Elizabethtown Community Hospital

    $ 48

    Moses Ludington Hospital

    $ 48

    Placid Memorial Hospital, Inc.

    $ 48

    FRANKLIN:

    Alice Hyde Memorial Hospital

    $ 28

    General Hospital of Saranac Lake

    $ 30

    FULTON:

    Johnstown Hospital

    $ 37

    Nathan Littauer Hospital

    $ 30

    GREENE:

    Memorial Hospital and Nursing Home of Greene County

    $ 37

    MONTGOMERY:

    Amsterdam Memorial Hospital

    $ 37

    St. Mary's Hospital at Amsterdam

    $ 37

    OTSEGO:

    Aurelia Osborn Fox Memorial Hospital

    $ 48

    Mary Imogene Bassett Hospital

    $ 48

    RENSSELAER:

    Leonard Hospital

    $ 37

    Samaritan Hospital of Troy

    $ 37

    St. Mary's Hospital of Troy

    $ 37

    SARATOGA:

    Adirondack Regional Hospital

    $ 30

    Saratoga Hospital

    $ 37

    SCHENECTADY:

    Bellevue Maternity Hospital, Inc.

    No E.R. service

    Ellis Hospital

    $ 48

    St. Clare's Hospital of Schenectady

    $ 30

    Sunnyview Hospital and Rehabilitation Center

    No E.R. service

    SCHOHARIE:

    Community Hospital of Schoharie County, Inc. $ 48

    WARREN:

    Glens Falls Hospital $ 30

    WASHINGTON:

    Emma Laing Stevens Hospital $ 48
    Mary McClellan Hospital $ 37

    Northern Metropolitan Region      

    DUTCHESS:

    Highland Hospital of Beacon $ 28
    Northern Dutchess Hospital $ 37
    St. Francis Hospital of Poughkeepsie $ 37
    Vassar Brothers Hospital $ 48

    ORANGE:

    Arden Hill Hospital $ 37
    Cornwall Hospital $ 30
    E.A. Horton Memorial Hospital $ 48
    Mercy Community Hospital of Port Jervis $ 28
    St. Anthony Community Hospital $ 30
    St. Luke's Hospital of Newburgh $ 30
    Tuxedo Memorial Hospital $ 48

    PUTNAM:

    Julia Butterfield Memorial Hospital $ 37
    Putnam Community Hospital $ 37

    ROCKLAND:

    Good Samaritan Hospital of Suffern $ 48
    Helen Hayes Hospital No E.R. service
    Nyack Hospital $ 47
    Summit Park Hospital--Rockland County Infirmary No E.R. service

    SULLIVAN:

    Community General Hospital of Sullivan County $ 48
    Community General Hospital of Sullivan County--G. Herman Div. $ 37

    ULSTER:

    Benedictine Hospital $ 37
    Ellenville Community Hospital $ 28
    Kingston Hospital $ 30

    WESTCHESTER:

    Blythedale Children's Hospital No E.R. service
    Burke Rehabilitation Center No E.R. service
    Dobbs Ferry Hospital $ 28
    Lawrence Hospital $ 48
    Mount Vernon Hospital $ 37
    New Rochelle Hospital Medical Center $ 48
    New York Hospital--Cornell Medical Center Westchester Division No E.R. service
    Northern Westchester Hospital $ 48
    Peekskill Hospital $ 30
    Phelps Memorial Hospital Association $ 48
    St. Agnes Hospital $ 48
    St. John's Riverside Hospital $ 30
    St. Joseph's Hospital, Yonkers $ 48
    St. Vincent's Hospital and Medical Center of New York--Westchester Branch No E.R. service
    United Hospital $ 28
    Westchester County Medical Center $ 48
    White Plains Hospital Medical Center $ 48
    Yonkers General Hospital $ 30

    Long Island Region

    NASSAU:

    Central General Hospital $ 48
    Community Hospital at Glen Cove $ 28
    Franklin General Hospital $ 48
    Hempstead General Hospital $ 48
    Long Beach Memorial Hospital $ 28
    Long Island Jewish--Hillside Medical Center (Manhasset Division) $ 48
    Lydia E. Hall Hospital $ 48
    Massapequa General Hospital $ 48
    Mercy Hospital of Rockville Centre $ 37
    Mid-Island Hospital $ 37
    Nassau County Medical Center--East Meadow Division $ 48
    Nassau Hospital (Winthrop-University Hospital) $ 37
    North Shore University Hospital $ 48
    South Nassau Communities Hospital $ 30
    St. Francis Hospital of Roslyn $ 48
    Syosset Community Hospital $ 48
    Winthrop--University Hospital (Nassau Hospital) $ 37

    SUFFOLK:

    Brookhaven Memorial Hospital $ 48
    Brunswick Hospital Center, Inc. $ 48
    Central Suffolk Hospital Association $ 28
    Eastern Long Island Hospital $ 28
    Good Samaritan Hospital of West Islip $ 37
    Huntington Hospital $ 30
    John T, Mather Memorial Hospital of Port Jefferson, New York, Inc. $ 48
    Smithtown General Hospital $ 48
    Southhampton Hospital $ 30
    Southside Hospital $ 48
    St. Charles' Hospital $ 37
    St. John's Episcopal Hospital, Smithtown $ 37
    University Hospital of Stony Brook $ 48

    NEW YORK CITY:

    Astoria General Hospital $ 30
    Baptist Medical Center of New York $ 28
    Bayley Seton Hospital $ 48
    Beth Israel Medical Center $ 48
    Booth Memorial Medical Center $ 48
    Boulevard Hospital $ 28
    Bronx-Lebanon Hospital Center $ 37
    Brookdale Hospital Medical Center $ 48
    Brooklyn/Caledonia Hospital $ 48
    Cabrini Health Care Center $ 48
    Calvary Hospital No E.R. service
    Catholic Medical Center $ 48
    Community Hospital of Brooklyn, Inc. $ 37
    Deepdale General Hospital $ 30
    Doctors Hospital, Inc. $ 48
    Doctors Hospital of Staten Island $ 37
    Flatbush General Hospital $ 28
    Flushing Hospital and Medical Center $ 30
    Hip Hospital, Inc. (La Guardia) $ 48
    Hospital for Joint Diseases and Medical Center Orthopedic Institute No E.R. service
    Hospital for Special Surgery No E.R. service
    Institute of Rehab Medicine NY University No E.R. service
    Interfaith Medical Center $ 48
    Jamaica Hospital $ 48
    Joint Diseases North General Hospital $ 48
    Kings Highway Hospital $ 30
    Kingsbrook Jewish Medical Center $ 48
    Lenox Hill Hospital $ 48
    Long Island College Hospital $ 48
    Long Island Jewish--Hillside Medical Center $ 48
    Lutheran Medical Center $ 48
    Maimonides Medical Center $ 48
    Manhattan Eye, Ear and Throat Hospital $ 30
    Medical Arts Center Hospital $ 30
    Memorial Hospital for Cancer and Allied Diseases No E.R. service
    Methodist Hospital of Brooklyn $ 48
    Misericordia Hospital Medical Center (Our Lady of Mercy Medical Center) $ 37
    Monteflore Hospital and Medical Center $ 48
    Mount Sinai Hospital $ 48
    New York Eye and Ear Infirmary No E.R. service
    New York Hospital and Payne Whitney Psychiatric Clinic $ 48
    New York Infirmary--Beekman Downtown Hospital $ 48
    New York University Medical Center $ 48
    Osteopathic/Hillcrest Hospital (St. Joseph's Hospital Div. of CMC) $ 48
    Our Lady of Mercy Medical Center $ 37
    Parkway Hospital $ 48
    Parsons Hospital $ 37
    Pelham Bay General Hospital $ 48
    Peninsula Hospital Center $ 48
    Physicians Hospital $ 28
    Presbyterian Hospital in the City of New York $ 48
    Prospect Hospital $ 28
    Richmond Memorial Hospital and Health Center $ 48
    Rockefeller University Hospital No E.R. service
    St. Barnabas Hospital $ 48
    St. Clare's Hospital and Health Center $ 48
    St. John's Episcopal Hospital $ 37
    St. Joseph's Hospital Division of CMC $ 48
    St. Luke's-Roosevelt Hospital Center $ 48
    St. Mary's Hospital of Brooklyn $ 48
    St. Vincent's Hospital and Medical Center of New York $ 48
    St. Vincent's Medical Center of Richmond $ 48
    State University Hospital--Downstate Medical Center No E.R. service
    Staten Island Hospital $ 48
    Union Hospital of The Bronx $ 28
    Victory Memorial Hospital $ 37
    Westchester Square Hospital $ 48
    Wyckoff Heights Hospital $ 37

    HEALTH AND HOSPITAL CORPORATION:

    Bellevue Hospital Center $ 48
    Bronx Municipal Hospital Center $ 37
    City Hospital Center at Elmhurst $ 28
    Coler Memorial Hospital and Home No E.R. service
    Coney Island Hospital $ 37
    Cumberland Hospital $ 30
    Goldwater Memorial Hospital No E.R. service
    Harlem Hospital Center $ 48
    Kings County Hospital Center $ 30
    Lincoln Medical and Mental Health Center $ 48
    Metropolitan Hospital Center $ 48
    North Central Bronx Hospital $ 48
    Queens Hospital Center $ 37
    Woodhull Medical and Mental Health Center $ 48

    Text current as of 10/03/2011

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