Telehealth Guidance

The Board has received inquiries regarding the proper method for payers to object to treatment via telehealth, in instances where the payer believes the use of telehealth was inappropriate and inconsistent with the regulation.

When a payer believes that treatment by a physician, nurse practitioner, physician assistant, or podiatrist via telehealth has been provided improperly pursuant to 12 NYCRR 325-1.26(b)(1), the fact that medical treatment was provided via telehealth should not be the sole basis for a legal objection to a bill for such treatment, and the services should be reimbursed, unless they are such that telehealth is clearly precluded by the regulation, e.g., initial visit with a provider, or visits to determine permanent impairment. In other more nuanced instances where the payer believes that medical services for a physical injury or illness are being improperly rendered via telehealth, the services should be reimbursed, but the payer may request that future similar services be conducted in-person by filing a Request for Further Action by Insurer/Employer (Form RFA-2). The payer should check box “K” and request a direction for a future in-person visit in accordance with the regulation, and state why the visit should not be performed via telehealth.

If a Board order to conduct a specific clinical service in-person instead of via telehealth is ignored or otherwise disregarded by the provider, the provider may be subject to administrative action. The payer should not file a Notice of Objection to a Payment of a Bill For Treatment Provided (Form C-8.1B). The filing of Form C-8.1B in these instances will be found moot.

Treatment rendered by chiropractors, acupuncturists, physical therapists, and occupational therapists under the New York workers’ compensation system may not be rendered via telehealth. When a payer believes that treatment has been improperly provided via telehealth by one of these provider types pursuant to 12 NYCRR 325-1.26(b)(3), the payer may file Form C-8.1B with the “Other” box checked and noting in the description that the provider type is not permitted to perform medical treatment via telehealth.

More information

Questions? Email Regulations@wcb.ny.gov.