Electronic submission offset billing disputes 

As part of the NYS Workers’ Compensation Board (Board) CMS-1500 electronic submission mandate, providers were instructed they may offset the cost of each electronic CMS-1500 bill submission, up to a maximum of one dollar, by using CPT code 99080.   

The Board has underscored that payers who do not properly reimburse providers for CPT code 99080 may be subject to penalties from the Board. Today, the Board is advising what providers should do if the offset is not paid, and the proper way for payers to object to an offset.

Effective March 31, 2026, in situations where the bill for services/treatment was paid or paid in part, but the offset code was not, providers may submit a Request for Decision on Unpaid Medical Bill(s) (Form HP-1.0). The Board may issue an administrative award on the payer for failure to pay the offset, including a $50 penalty for each instance of nonpayment for which a Form HP-1.0 is submitted, per WCL §13-g. 

For payers, if the only code on a bill they are objecting to is 99080, the payer should note this objection in the Explanation of Benefits. It is not appropriate to use a Notice to Health Care Provider and Claimant of an Insurer's Refusal to Pay All (or a portion) of a Medical Bill Due to Valuation Objection(s) (Form C-8.4) or Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B) for this situation.

Note: the only valid objections to payment of the 99080 offset on a bill for which the medical services or goods were reimbursed (all or in part) is that the requested offset exceeds the regulatorily permissible amount, or that offset code 99080 appears more than once on the same bill.

CMS-1500 electronic submission mandate 

The requirement to submit CMS-1500 bills electronically via a Board-approved electronic submission partner went into effect August 1, 2025. If you have not obtained an electronic submission partner, you should do so immediately. 

The mandate applies to each individual provider in a practice who treats workers’ compensation patients.  

Payers can deny payment of services if the CMS-1500 form is not submitted through a Board-approved electronic submission partner and the Board will not enforce payment. 

Submitting the CMS-1500 electronically has significant benefits, namely, faster bill payments. Visit the CMS-1500 section of the Board’s website for a complete list of benefits. 

More information 

See our fact sheet for more information and visit wcb.ny.gov/CMS-1500 for complete details. 

Questions? Email CMS1500@wcb.ny.gov.