(1) The RVU for CPT code 87635 shall be $39.18, and the total fee for such test shall be $51.33 for Region IV, $47.41 for Region III, and $41.53 for Regions I and II.

(2) CPT code 87635 may only be billed when there is a claim for workers’ compensation due to a COVID-19 infection as a result of a work-place exposure.

(3) CPT code 87635 may not be billed for routine screening of workers’ compensation claimants for the presence of the COVID-19 virus.

(4) Antibody testing is not available under the Official New York Workers’ Compensation Fee Schedule.

(5) CPT code 87635 may only be billed in one instance. Repeat testing is not permitted.

1. Statutory authority: Workers’ Compensation Law (WCL) § 117(1) authorizes the Chair of the Workers’ Compensation Board (Board) to adopt reasonable rules consistent with, and supplemental to, the provisions of the WCL.

2. Legislative objectives: The emergency adoption allows reimbursement for COVID-19 testing when there is a claim for workers’ compensation benefits due to work-place exposure to COVID-19.

3. Needs and benefits: To provide reimbursement for COVID-19 testing when it is necessary because workers’ compensation benefits are being sought due to work-place exposure to COVID-19, in order to confirm current presence of the COVID-19 virus.

4. Costs: The emergency adoption is not expected to have a significant impact on costs, as reimbursement is limited to situations where the employee has had a work-place exposure to the virus.

5. Local government mandates: The proposed amendments do not impose any program, service, duty, or responsibility upon any county, city, town, village, school district, fire district, or other special district.

6. Paperwork: The emergency adoption requires authorized providers to use a CPT code to bill for COVID-19 testing as described above.

7. Duplication: The emergency adoption does not duplicate other regulatory initiatives.

8. Alternatives: An alternative would be to not file an emergency adoption addressing the reimbursement of COVID-19 testing, but without a confirmatory test, there would be no way of showing a workers’ compensation claimant is currently infected with COVID-19 when benefits are sought due to workplace exposure.

9. Federal standards. There are no applicable Federal Standards.

10. Compliance schedule: The emergency adoption takes effect immediately upon filing but simply provides guidelines for use of a CPT code that may be used in limited circumstances to confirm COVID-19 infection when workers’ compensation benefits are sought due to work-place exposure to COVID-19.

A Regulatory Flexibility Analysis is not required because the emergency adoption will not have any adverse economic impact or impose any new reporting, recordkeeping or other compliance requirements on small businesses or local governments. The emergency adoption allows authorized providers to be reimbursed for COVID-19 testing when workers’ compensation benefits are sought due to work-place exposure to COVID-19.

A Rural Area Flexibility Analysis is not required because the emergency adoption will not have any impact rural areas. The emergency adoption allows authorized providers to be reimbursed for COVID-19 testing when workers’ compensation benefits are sought due to work-place exposure to COVID-19.

A Job Impact Statement is not required because the emergency adoption will not have any impact on jobs or employment opportunities. The emergency adoption allows authorized providers to be reimbursed for COVID-19 testing when workers’ compensation benefits are sought due to work-place exposure to COVID-19.