Key Takeaway
NY Workers' Compensation Board clarifies 8 RVU limitation rules for physical therapy and chiropractic treatment in no-fault insurance claims.
This is from the Vice President of James Skelton, Esq., from AAA today (4-23-18) – It is for everybody’s edification:
Dear Jason – The Workers’ Compensation Board has recently advised the Department that the following email regarding PT rules is not the Board’s official position. If you have any questions, please contact Chris Maloney at chris.maloney@dfs.ny.gov or (212) 480-5586.
Christopher Maloney
Supervising Insurance Examiner
Property Bureau – Claims Administration Unit
New York State Department of Financial Services
One State Street Plaza, 6th floor, New York, NY 10004+1511
Ph: (212) 480-5586 | Fax: (212) 709-1570 | chris.maloney@dfs.ny.gov
From: MacMaster, Heather (WCB)
Sent: Tuesday, January 30, 2018 3:59 PM
To: Maloney, Chris (DFS) Chris.Maloney@dfs.ny.gov
Cc: Woods, MaryBeth (WCB) MaryBeth.Woods@wcb.ny.gov; Smith, Steven (WCB) Steven.Smith@wcb.ny.gov
Subject: Fee Schedule: PT rules
Chris:
Here is the PT information from our MDO.
The 8 RVU limitation is per patient per day regardless of how many body parts are treated or how many practitioners treat. The only exception is with chiro and PT. If a chiro renders manipulation only (98940-98943) and does not bill any of the other physical medicine codes, the injured worker could receive chiro and PT on the same day. This scenario is usually performed by a chiro who is affiliated with the Chiropractic Council. They only perform manipulation.
The physical medicine codes that are impacted by the 8 RVU limitation are in the chiro physical medicine fee schedule but the codes for spinal manipulation are not in the general physical medicine fee schedule.
Thanks,
Heather
Heather MacMaster
Deputy General Counsel
NYS Workers’ Compensation Board
328 State Street, Schenectady, NY 12305
(518) 486-9564 | heather.macmaster@wcb.ny.gov
http://www.WCB.NY.Gov
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James Skelton
Vice President
American Arbitration Association
32 Old Slip, 33rd Floor, New York, NY 10005
www.adr.org
T: 917 438 1562
Our office has moved. The new address is 32 Old Slip, 33rd fl, New York, NY 10005
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Legal Update (February 2026): Since this 2018 post regarding the 8 RVU limitation for physical therapy services, the Workers’ Compensation Board’s fee schedule and reimbursement guidelines may have been substantially revised. Practitioners should verify current RVU limitations, co-treatment rules between chiropractors and physical therapists, and any updated physical medicine billing codes with the WCB and Department of Financial Services, as these provisions are subject to periodic regulatory amendments.
