The official Notice of Adoption from the New York State Workers’ Compensation Board (WCB) of the new Dental Fee Schedule has been published in the New York State Register today and is effective November 13, 2025.  NYSDA is specifically mentioned in the Assessment of Public Comment section of the Notice.  You can read the complete Notice of Adoption below.

Workers’ Compensation Board

NOTICE OF ADOPTION

Dental Fee Schedule

I.D. No. WCB-26-25-00003-A

Filing No. 917

Filing Date: 2025-10-24

Effective Date: 2025-11-13

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Action taken: Amendment of section 444.2 of Title 12 NYCRR.

Statutory authority: Workers’ Compensation Law, sections 117 and 141

Subject: Dental Fee Schedule.

Purpose: To update the dental fee schedule.

Text of final rule: Section 444.2 of Title 12 NYCRR is hereby amended to read as follows:

Section 444.2.  Fee Schedule

(a) The dental fee schedule for all dental services shall be the Official New York Workers’ Compensation Dental Fee Schedule, [First] Second Edition, [March 1, 2009] November 2025, prepared by the Chair and published by the Board, which is hereby incorporated by reference, except that the maximum reimbursement for dental services in cases in which the insurance carrier files or has filed a notice of controversy pursuant to Workers’ Compensation Law section 25(2)(a) or (b) shall be 25 percent more than the fees set forth in the Official New York Workers’ Compensation Dental Fee Schedule.  Upon resolution of the controverted claim in favor of the claimant, payers shall automatically add 25 percent to any dental bill that was billed in accordance with the Official New York Workers’ Compensation Dental Fee Schedule during the pendency of the controversy.  When a dentist knows at the time of submission of a bill that the claim is being controverted, the dentist should use modifier 1C to identify the 25 percent increase, but the 25 percent increase cannot be denied solely because of the absence of modifier 1C on the original bill.

(b) The Official New York Workers’ Compensation Dental Fee Schedule incorporated by reference herein may be examined at the office of the Department of State, 99 Washington Avenue, Suite 650, Albany, NY 12231, the Legislative Library, the libraries of the New York State Supreme Court, [and] the district offices of the Board [in Albany, Binghamton, Brooklyn, Buffalo, Hauppauge, Hempstead, Manhattan, Peekskill, Queens, Rochester and Syracuse,] as well as available for viewing free of charge on the board’s website. [Copies may be obtained from the Board by writing to New York Workers’ Compensation Dental Fee Schedule, Bureau of Health Management, New York State Workers’ Compensation Board, 100 Broadway - Menands, Albany, NY 12241 or by telephone at 1-800-7812362 or by email at general_information@wcb.state.ny.us]

(c) The Official New York Workers’ Compensation [d]Dental [f]Fee [s]Schedule shall be updated by the Chair as he or she deems warranted by changes in market rates.  The [d]Dental [f]Fee [s]Schedule consists of a list of Current Dental Terminology (CDT) codes and descriptions of treatment services and procedures as published by the American Dental Association with a corresponding maximum fee to be charged by [dental providers] dentists.  Nothing shall prohibit a [provider] dentist from charging a fee that is less than the Dental [f]Fee [s]Schedule.

(d) [Any treatment or procedure provided in connection with a work related injury not specifically contained in the dental fee schedule should be billed using CDT code D9999 “Unspecified Adjunctive Procedure By Report” (BR). The provider should establish a fee consistent in relativity with the other fees listed in the dental fee schedule. Any bill submitted by a dental provider which lists CDT Code D9999 shall be accompanied by a report providing the reasons why such procedure is necessary to treat the injured employee.] Except in emergencies, any procedure or item over $1,000 or represented by CDT Code D9999 (“Unspecified Adjunctive Procedure By Report - BR”) requires a Prior Authorization Request (PAR).  Any treatment or procedure provided in connection with a work-related injury not specifically contained in the Official New York Workers’ Compensation Dental Fee Schedule should be billed using CDT code D9999.  Any bill submitted by a dentist which lists CDT Code D9999 shall be accompanied by an additional report providing the reason(s) why such procedure is necessary to treat the injured employee, and why an existing Dental Fee Schedule code could not be utilized.  When billing CDT Code D9999, the dentist should reference a comparable code and pricing from the current Dental Fee Schedule, reflecting a similar amount of work, materials and resources, relative to the procedure being requested or performed.

(e) Inclusion of any particular code in this fee schedule does not guarantee reimbursement for that code.  Reimbursement may be dependent on multiple factors, including but not necessarily limited to, causal relationship, clinical necessity and appropriateness of the fees submitted.

(f) Physicians (MD, DO, MBBS) with specialized training such as otorhinolaryngology may on occasion perform procedures whose codes are contained within the Official New York Workers’ Compensation Dental Fee Schedule, if such procedures are consistent with their training and scope of practice.  In such instances, such physicians may use the applicable codes within the Dental Fee Schedule or the applicable codes within the Surgery section of the Official New York Workers’ Compensation Medical Fee Schedule.

Final rule as compared with last published rule: Nonsubstantial changes were made in section 442.4.

Text of rule and any required statements and analyses may be obtained from: Courtney Vallee, NYS Workers’ Compensation Board, Office of General Counsel, 328 State Street, Schenectady, NY 12304, (518) 486- 9564, email: regulations@wcb.ny.gov

Revised Regulatory Impact Statement

A revised Regulatory Impact Statement is not required because the changes made to the last published rule do not necessitate revision to the previously published document.  These changes do not affect the meaning of any statements in the document.

Revised Regulatory Flexibility Analysis

A revised Regulatory Flexibility Analysis is not required because the changes made to the last published rule do not necessitate revision to the previously published document.  These changes do not affect the meaning of any statements in the document.

Revised Rural Area Flexibility Analysis

A revised Rural Area Flexibility Analysis is not required because the changes made to the last published rule do not necessitate revision to the previously published document.  These changes do not affect the meaning of any statements in the document.

Revised Job Impact Statement

A Job Impact Statement is not required because the proposed regulation will not have any impact, adverse or otherwise, on jobs or employment opportunities.  The proposed amendments update fees for dental treatment.

Initial Review of Rule

As a rule that requires a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2028, which is no later than the 3rd year after the year in which this rule is being adopted.

Assessment of Public Comment

During the public comment period, the Board received two comments.

The first comment from an association strongly supported the proposal and opined that it “would reflect the State’s ongoing commitment to fairness, quality, and access in the Workers’ Compensation system, aligning dental fees with the standards of other healthcare services.”

The other comment, from an individual provider, requested the inclusion of a small number of highly-specialized codes for highly-specialized services, for a condition not typically seen among injured workers, along with suggested fees for same.  This suggestion was not echoed by the New York State Dental Association, or any other authoritative sources or commenters.  Moreover, there are other codes available in the fee schedule that can be used for these procedures.  Upon due consideration, the Board has elected to not incorporate the requested changes at this time, but can revisit the suggestion with the next version of the Dental Fee Schedule, should the need be deemed compelling.

Changes made:

• Update to date in regulation text to reflect October adoption/November effective date (rather than June proposal)