Reimbursement rates for hospital & health related services under no-fault. (See also CL 4 (1980) and CL 1 (1981) both on this listing).

September 29, 1980 SUBJECT: INSURANCE Circular Letter No. 14 (1980) WITHDRAWN TO: All Insurers Licensed to Write Automobile Insurance in New York State SUBJECT: Reimbursement Rates for Hospital and Health Related Services Under No-Fault Pursuant to the provisions of 11 NYCRR 63.2 (Regulation 83), on and after January 1, 1978, the schedule of all inclusive rates for hospital services and health related services, including home health services, provided pursuant to Section 671(1)(a) of the Insurance Law shall be the rates approved by the Chairman of the Workers" Compensation Board in accordance with the provisions of Chapter 767 of the Laws of 1977. Pursuant to the provisions of Regulation 83 and effective with services rendered on and after July 1, 1980 through December 31, 1980, the attached schedule shall be utilized by no-fault insurers for payment of hospital in-patient services. The rates appearing in the attached schedule have been developed in accordance with Chapter 767 of the Laws of 1977 as amended by Chapter 213 of the Laws of 1978 and Chapter 271 of the Laws of 1979 and have been approved by the Chairman of the Workers" Compensation Board. Also attached is a notice of the merger of Baptist Hospital of New York and Interboro Hospital into a single entity under the name of Baptist Medical Center of New York. It should be noted that the interim rate contained therein, approved by the Chairman of the Workers" Compensation Board, has been revised effective July 1, 1980. Pursuant to the provisions of Regulation 83 these rates shall be utilized by no-fault insurers for payment of hospital in-patient services for the effective periods set forth in the notice and revised hospital schedule. Very truly yours, [SIGNATURE] ALBERT B. LEWIS Superintendent of Insurance Attach. STATE OF NEW YORK WORKERS" COMPENSATION BOARD OFFICE OF THE CHAIRMAN HOSPITAL FEE SCHEDULE Effective January 1, 1980 Revision No. 1 September 9, 1980 This revision of the Hospital Fee Schedule was recommended and certified by the State Commissioner of Health and approved by the Chairman of the Workers' Compensation Board. Pursuant to Chapter 767, Laws of 1977, as amended by Chapter 213, Laws of 1978 and Chapter 271, Laws of 1979, these rates are for use in payment of claims under the Workers' Compensation Law and the Volunteer Firemen's Benefit Law. Except as otherwise noted, these revisions are effective July 1, 1980 - December 31, 1980. [SIGNATURE] Chairman WORKERS' COMPENSATION SCHEDULE OF RATES FOR THE PERIOD JANUARY 1, 1980 THROUGH DECEMBER 31, 1980 Rates for Outpatient Services Room other than operating room or operating room when used for minor surgery or emergency treatment: For the medical service provided whether by employed staff, attending staff or by contractual arrangement with the physician groups the fee for this service is limited to the first visit fee of as appears on line 90010 of the Schedule of Medical Fees. $ 13.00 For the hospital providing intern or resident staffing or by physician group contractual coverage the total fee is $ 36.00 When the care is provided by an attending, the hospital fee is with the physician billing separately. $ 23.00 Note: These fees include common or ordinary medications. Crutches, mechanical splints and appliances Rental or Sale at Cost Plaster Cast and/or Splint Cost of Plaster Radium and deep therapy A & A* E.K.G., E.E.G., X-ray, P.T., and Laboratory Charges Rates in Schedule of Medical Fees Promulgated by the Chairman, Workers" Compensation Board Materials supplied by the Emergency Room (i.e. sterile trays, medications, etc.) over and above those usually included with the Emergency Room visit may be charged for separately. Itemize these on the bill submitted. * "Authorization and Arrangement" (Revised 9/9/80) COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES A study was undertaken to determine the low-cost drugs which a large number of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive Emergency Room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list or heretofore regarded as common or ordinary or any additional drugs so regarded should be considered as covered by the applicable Emergency Room rate. No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients. Current List of "No Charge" Drugs and Pharmaceutical Supplies Alcohol 70% Alcohol swabs Antacid (e.g. Mylanta, Maalox, etc.) Acetaminophen 325 mg. tablet (e.g. Tylenol-Topar Empracet) Aspirin 325 mg. tablet (e.g. Bayer) Aromatic Sp. Ammonia Atropine 2% O.S. Atropine .4mg/ml Bacitracin Ointment Castor Oil Calamine lotion Collodian Flexible Cold Cream Clinitest tablets Cortisporin ophthalmic solution Dibucaine 1% ointment (e.g. Nupercaine) Ethyl Chloride spray Gamma Benzene Lotion (e.g. Kwell) Gelfoam Glycerin suppository Hematest tablets Hydrocortisone 1% ointment Hydrogen peroxide Iodine Ipecac Lidocaine 2% viscous (e.g. Xylocaine) Lidocaine 1% w/or without epinephrine (e.g. Xylocaine) Lidocaine 2% w/or without epinephrine (e.g. Xylocaine) Lidocaine 5% ointment (e.g. Xylocaine) Lubricating Jelly Magnesium sulfate (e.g. Epsom salts) Meperidine injection (e.g. Demerol) Merthiolate Nitroglycerin s.1 .4 mg Nitroglycerin s.1 .6 mg Peppermint spirit Petrolatum Povidone-Iodine solution (e.g. Betadine) Pralidoxine (e.g. Protopam - Ayerst) Silver nitrate sticks Silver sulfadiazine (e.g. Silvadene - Marion) Sodium chloride - injection Sodium chloride for irrigation Sterile water for irrigation Talcum powder Tetanus Toxoid Tuberculin PPD (1st & 2nd strength) Witch hazel Zinc oxide ointment WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE WESTERN NEW YORK REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Western New York region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: ALLEGANY CUBA MEMORIAL HOSPITAL INC * $ 189.00 ALL INCLUSIVE INPATIENT ACUTE CARE MEMORIAL HOSPITAL OF WM F & GERTRUDE F JONES A/K/A JONES MEMORIAL INPATIENT ACUTE CARE * $ 170.00 ALL INCLUSIVE CATTARAUGUS OLEAN GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 167.00 A SALAMANCA HOSPITAL DISTRICT AUTHORITY INPATIENT ACUTE CARE * $ 137.00 C ST FRANCIS HOSPITAL INPATIENT ACUTE CARE * $ 161.00 B TRI-COUNTY MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 133.00 A,B CHAUTAUQUA BROOKS MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 140.00 A,B JAMESTOWN GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 151.00 A,B,C LAKE SHORE HOSPITAL INC INPATIENT ACUTE CARE * $ 147.00 A,B WESTFIELD MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 178.00 B WOMANS CHRISTIAN ASSOCIATION INPATIENT ACUTE CARE * $ 159.00 A,B ERIE BERTRAND CHAFFEE HOSPITAL INPATIENT ACUTE CARE * $ 167.00 ALL INCLUSIVE BRY-LIN HOSPITAL PSYCHIATRIC CARE * $ 142.00 A,B BUFFALO COLUMBUS HOSPITAL INPATIENT ACUTE CARE * $ 110.00 C BUFFALO GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 192.00 A CHILDRENS HOSPITAL INPATIENT ACUTE CARE * $ 289.00 A ERIE COUNTY MEDICAL CENTER INPATIENT ACUTE CARE * $ 205.00 ALL INCLUSIVE KENMORE MERCY HOSPITAL INPATIENT ACUTE CARE * $ 164.00 A, OTHER: EKG LAFAYETTE GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 132.00 A MERCY HOSPITAL OF BUFFALO INPATIENT ACUTE CARE * $ 157.00 A, OTHER: ECHOCARDIOGRAMS MILLARD FILLMORE HOSPITAL INPATIENT ACUTE CARE * $ 194.00 A OUR LADY OF VICTORY HOSPITAL OF LACKAWANNA INPATIENT ACUTE CARE * $ 162.00 A,B, OTHER: ENDOSCOPY, STRESS TESTS -- SONOGRAMS, ECHOCARDIOGRAMS ERIE ROSWELL PARK MEMORIAL INSTITUTE INPATIENT ACUTE CARE * $ 257.00 ALL INCLUSIVE SAINT FRANCIS HOSPITAL OF BUFFALO INPATIENT ACUTE CARE * $ 143.00 A SHEEHAN MEMORIAL EMERGENCY HOSPITAL INC INPATIENT ACUTE CARE * $ 160.00 A,B SHERIDAN PARK HOSPITAL INC INPATIENT ACUTE CARE * $ 147.00 A SISTERS OF CHARITY HOSPITAL INPATIENT ACUTE CARE * $ 164.00 A ST JOSEPH INTERCOMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 132.00 A GENESEE GENESEE MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 161.00 A ST JEROME HOSPITAL INPATIENT ACUTE CARE * $ 170.00 A NIAGARA DEGRAFF MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 153.00 A INTER-COMMUNITY MEMORIAL HOSPITAL AT NEWFANE INC INPATIENT ACUTE CARE * $ 144.00 A LOCKPORT MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 159.00 A,B MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS INPATIENT ACUTE CARE * $ 162.00 A NIAGARA FALLS MEMORIAL MEDICAL CENTER INPATIENT ACUTE CARE * $ 180.00 A ORLEANS ARNOLD GREGORY MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 162.00 A MEDINA MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 149.00 A,B WYOMING WYOMING COUNTY COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 175.00 A A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE ROCHESTER NEW YORK REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Rochester region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: CHEMUNG ARNOT-OGDEN MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 184.00 A ST JOSEPHS HOSPITAL OF ELMIRA INPATIENT ACUTE CARE * $ 153.00 A LIVINGSTON NICHOLAS H NOYES MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 178.00 A MONROE GENESEE HOSPITAL INPATIENT ACUTE CARE * $ 272.00 A HIGHLAND HOSPITAL INPATIENT ACUTE CARE * $ 235.00 A,B LAKESIDE MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 182.00 A MONROE COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 298.00 ALL INCLUSIVE PARK RIDGE HOSPITAL INPATIENT ACUTE CARE * $ 214.00 A,B ROCHESTER GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 268.00 A ST MARYS HOSPITAL OF ROCHESTER INPATIENT ACUTE CARE * $ 214.00 A,C STRONG MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 307.00 A,D, OTHER: DIAGNOSTIC RADIOLOGY ONTARIO CLIFTON SPRINGS HOSPITAL AND CLINIC INPATIENT ACUTE CARE * $ 166.00 A F F THOMPSON HOSPITAL INPATIENT ACUTE CARE * $ 147.00 A GENEVA GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 193.00 A SCHUYLER SCHUYLER HOSPITAL INPATIENT ACUTE CARE * $ 184.00 A SENECA SENECA FALLS HOSPITAL INPATIENT ACUTE CARE * $ 177.00 A WATERLOO MEMORIAL HOSPITAL INC. D/B/A TAYLOR-BROWN MEMORIAL HOSP INPATIENT ACUTE CARE * $ 153.00 A STEUBEN BETHESDA HOSPITAL INPATIENT ACUTE CARE * $ 168.00 A,B CORNING HOSPITAL INPATIENT ACUTE CARE * $ 170.00 A IRA DAVENPORT MEMORIAL HOSPITAL INC. INPATIENT ACTUE CARE * $ 155.00 A,C ST JAMES MERCY HOSPITAL INPATIENT ACUTE CARE * $ 145.00 A,B WAYNE MYERS COMMUNITY HOSPITAL FOUNDATION INC INPATIENT ACUTE CARE * $ 159.00 A NEWARK-WAYNE COMMUNITY HOSPITAL INC INPATIENT ACUTE CARE * $ 180.00 A YATES SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY INC INPATIENT ACUTE CARE * $ 171.00 A A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE CENTRAL NEW YORK REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Central New York region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: BROOME BINGHAMTON GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 182.00 A,B,C CHARLES S WILSON MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 217.00 A IDEAL HOSPITAL OF ENDICOTT INPATIENT ACUTE CARE * $ 188.00 A OUR LADY OF LOURDES MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 175.00 A, OTHER: DIAGNOSTIC RADIOLOGY ULTRASOUND CAYUGA AUBURN MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 170.00 A CHENANGO CHENANGO MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 215.00 A CORTLAND CORTLAND MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 206.00 A,B HERKIMER HERKIMER MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 176.00 A LITTLE FALLS HOSPITAL INPATIENT ACUTE CARE * $ 150.00 A MOHAWK VALLEY GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 156.00 A JEFFERSON CARTHAGE AREA HOSPITAL INC INPATIENT ACUTE CARE * $ 165.00 B EDWARD JOHN NOBLE HOSPITAL OF ALEXANDRIA BAY INPATIENT ACUTE CARE * $ 184.00 ALL INCLUSIVE HOUSE OF THE GOOD SAMARITAN INPATIENT ACUTE CARE * $ 174.00 A,B,C MERCY HOSPITAL OF WATERTOWN INPATIENT ACUTE CARE * $ 190.00 A,B LEWIS LEWIS COUNTY GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 196.00 B MADISON COMMUNITY MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 191.00 A ONEIDA CITY HOSPITAL INPATIENT ACUTE CARE * $ 160.00 A,D ONEIDA CHILDRENS HOSPITAL AND REHABILITATION CENTER REHABILITATION * $ 182.00 A,C, OTHER: EMG ONEIDA FAXTON HOSPITAL INPATIENT ACUTE CARE * $ 205.00 A,C, OTHER: EMG ROME HOSPITAL AND MURPHY MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 158.00 A,C ROSE HOSPITAL INPATIENT ACUTE CARE * $ 150.00 A,C ST ELIZABETH HOSPITAL INPATIENT ACUTE CARE * $ 206.00 A,C ST LUKES MEMORIAL HOSPITAL CENTER INPATIENT ACUTE CARE * $ 194.00 A,C, OTHER: EMG ONONDAGA BENJAMIN RUSH CENTER PSYCHIATRIC CARE * $ 125.00 ALL INCLUSIVE COMMUNITY-GENERAL HOSPITAL OF GREATER SYRACUSE INPATIENT ACUTE CARE * $ 238.00 A CROUSE-IRVING MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 277.00 A,B,D, OTHERS: NUCLEAR MEDICINE, EEG, EKG ST JOSEPHS HOSPITAL HEALTH CENTER INPATIENT ACUTE CARE * $ 232.00 A,B,C STATE UNIVERSITY HOSPITAL UPSTATE MEDICAL CENTER INPATIENT ACUTE CARE * $ 253.00 A OSWEGO ALBERT LINDLEY LEE MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 179.00 A OSWEGO HOSPITAL INPATIENT ACUTE CARE * $ 172.00 A ST. LAWRENCE A BARTON HEPBURN HOSPITAL INPATIENT ACUTE CARE * $ 203.00 A CENTRAL ST LAWRENCE HLTH SERVICES OF POTSDAM HOSP INPATIENT ACUTE CARE * $ 186.00 A, OTHER: EKG, PFT CLIFTON-FINE HOSPITAL INPATIENT ACUTE CARE * $ 189.00 ALL INCLUSIVE EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR INPATIENT ACUTE CARE * $ 134.00 ALL INCLUSIVE MASSENA MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 184.00 A TIOGA TIOGA GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 169.00 A TOMPKINS TOMPKINS COUNTY HOSPITAL INPATIENT ACUTE CARE * $ 220.00 A,B A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE NORTHEASTERN NEW YORK REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Northeastern New York region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: ALBANY ALBANY MEDICAL CENTER HOSPITAL INPATIENT ACUTE CARE * $ 210.00 A,B CHILDS HOSPITAL INPATIENT ACUTE CARE * $ 170.00 A COHOES MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 154.00 A,B MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 203.00 A ST PETERS HOSPITAL INPATIENT ACUTE CARE * $ 207.00 A,B CLINTON CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR INPATIENT ACUTE CARE * $ 142.00 A,B, OTHER: EKG COLUMBIA COLUMBIA MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 174.00 B DELAWARE A LINDSAY & OLIVE B OCONNOR HOSPITAL INPATIENT ACUTE CARE * $ 175.00 ALL INCLUSIVE COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 183.00 ALL INCLUSIVE DELAWARE VALLEY HOSPITAL INC INPATIENT ACUTE CARE * $ 209.00 ALL INCLUSIVE MARGARETVILLE MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 201.00 ALL INCLUSIVE READ MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 177.00 A,B THE HOSPITAL INPATIENT ACUTE CARE * $ 160.00 A,B, OTHER: ULTRASOUND, ELECTRO- CARDIOLOGY ESSEX ELIZABETHTOWN COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 169.00 B MOSES-LUDINGTON HOSPITAL INPATIENT ACUTE CARE * $ 168.00 B,C PLACID MEMORIAL HOSPITAL INC INPATIENT ACUTE CARE * $ 159.00 A,B FRANKLIN ALICE HYDE MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 148.00 B GENERAL HOSPITAL OF SARANAC LAKE INPATIENT ACUTE CARE * $ 161.00 A,B,C MERCY GENERAL HOSPITAL OF TUPPER LAKE INPATIENT ACUTE CARE * $ 162.00 B FULTON JOHNSTOWN HOSPITAL INPATIENT ACUTE CARE * $ 168.00 A NATHAN LITTAUER HOSPITAL INPATIENT ACUTE CARE * $ 161.00 A GREENE MEMORIAL HOSPITAL OF GREENE COUNTY INPATIENT ACUTE CARE * $ 183.00 ALL INCLUSIVE MONTGOMERY AMSTERDAM MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 165.00 A,C ST MARYS HOSPITAL AT AMSTERDAM INPATIENT ACUTE CARE * $ 157.00 A,C OTSEGO AURELIA OSBORN FOX MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 202.00 A MARY IMOGENE BASSETT HOSPITAL INPATIENT ACUTE CARE * $ 191.00 ALL INCLUSIVE RENSSELAER LEONARD HOSPITAL INPATIENT ACUTE CARE * $ 168.00 B,C SAMARITAN HOSPITAL OF TROY INPATIENT ACUTE CARE * $ 175.00 A ST MARYS HOSPITAL OF TROY INPATIENT ACUTE CARE * $ 175.00 A,B SARATOGA ADIRONDACK REGIONAL HOSPITAL INPATIENT ACUTE CARE * $ 128.00 ALL INCLUSIVE BENEDICT MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 73.00 A,C SARATOGA HOSPITAL INPATIENT ACUTE CARE * $ 177.00 A,B SCHENECTADY BELLEVUE MATERNITY HOSPITAL INC INPATIENT ACUTE CARE * $ 276.00 A ELLIS HOSPITAL INPATIENT ACUTE CARE * $ 189.00 A,B,C, OTHER: NUCLEAR MEDICINE ST CLARES HOSPITAL OF SCHENECTADY INPATIENT ACUTE CARE * $ 183.00 A,B SUNNYVIEW HOSPITAL AND REHABILITATION CENTER INPATIENT ACUTE CARE * $ 166.00 A,C SCHOHARIE COMMUNITY HOSPITAL OF SCHOHARIE COUNTY INC INPATIENT ACUTE CARE * $ 155.00 ALL INCLUSIVE WARREN GLENS FALLS HOSPITAL INPATIENT ACUTE CARE * $ 182.00 A,B,C WASHINGTON EMMA LAING STEVENS HOSPITAL INPATIENT ACUTE CARE * $ 149.00 ALL INCLUSIVE MARY MCCLELLAN HOSPITAL INPATIENT ACUTE CARE * $ 158.00 A A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE NORTHERN METROPOLITAN REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Northern Metropolitan region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: DUTCHESS HIGHLAND HOSPITAL OF BEACON INPATIENT ACUTE CARE * $ 159.00 A NORTHERN DUTCHESS HOSPITAL INPATIENT ACUTE CARE * $ 170.00 A ST FRANCIS HOSPITAL OF POUGHKEEPSIE INPATIENT ACUTE CARE * $ 208.00 A VASSAR BROTHERS HOSPITAL INPATIENT ACUTE CARE * $ 199.00 A,B,C ORANGE ARDEN HILL HOSPITAL INPATIENT ACUTE CARE * $ 231.00 A,C CORNWALL HOSPITAL INPATIENT ACUTE CARE * $ 174.00 A DOCTORS SUNNYSIDE HOSPITAL INPATIENT ACUTE CARE * $ 171.00 ALL INCLUSIVE E A HORTON MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 191.00 A FALKIRK HOSPITAL PSYCHIATRIC CARE * $ 131.00 ALL INCLUSIVE ST ANTHONY COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 212.00 ALL INCLUSIVE ST FRANCIS HOSPITAL OF PORT JERVIS NEW YORK INPATIENT ACUTE CARE * $ 191.00 A,C ST LUKES HOSPITAL OF NEWBURGH INPATIENT ACUTE CARE * $ 213.00 A TUXEDO MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 148.00 ALL INCLUSIVE PUTNAM JULIA L BUTTERFIELD MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 245.00 A PUTNAM COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 222.00 A ROCKLAND COMMUNITY HOSPITAL OF ROCKLAND COUNTY INPATIENT ACUTE CARE * $ 135.00 A GOOD SAMARITAN HOSPITAL OF SUFFERN INPATIENT ACUTE CARE * $ 258.00 A, OTHER: EMG HELEN HAYES HOSPITAL INPATIENT ACUTE CARE * $ 260.00 ALL INCLUSIVE NYACK HOSPITAL INPATIENT ACUTE CARE * $ 237.00 A,B SUMMIT PARK HOSPITAL-ROCKLAND COUNTY INFIRMARY INPATIENT ACUTE CARE * $ 123.00 ALL INCLUSIVE PSYCHIATRIC CARE * $ 215.00 ALL INCLUSIVE SULLIVAN COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY INPATIENT ACUTE CARE * $ 272.00 A COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY G HERMAN DIV INPATIENT ACUTE CARE * $ 154.00 A HAMILTON AVENUE HOSPITAL INPATIENT ACUTE CARE * $ 144.00 ALL INCLUSIVE ULSTER BENEDICTINE HOSPITAL INPATIENT ACUTE CARE * $ 166.00 ALL INCLUSIVE ELLENVILLE COMMUNITY HOSPITAL INPATIENT ACUTE CARE * $ 175.00 ALL INCLUSIVE KINGSTON HOSPITAL INPATIENT ACUTE CARE * $ 176.00 A WESTCHESTER BLYTHEDALE CHILDRENS HOSPITAL INPATIENT ACUTE CARE * $ 197.00 ALL INCLUSIVE BURKE REHABILITATION CENTER INPATIENT ACUTE CARE * $ 274.00 A DOBBS FERRY HOSPITAL INPATIENT ACUTE CARE * $ 159.00 A FOUR WINDS HOSPITAL PSYCHIATRIC CARE * $ 176.00 A,B,C,D LAWRENCE HOSPITAL INPATIENT ACUTE CARE * $ 227.00 A MENTAL RETARDATION INSTITUTE NY FLOWER & FIFTH AV HOSP MEDICAL MENTAL RETARDATION ACUTE CARE $ 209.00 ALL INCLUSIVE MOUNT VERNON HOSPITAL INPATIENT ACUTE CARE * $ 233.00 A NEW ROCHELLE HOSPITAL MEDICAL CENTER INPATIENT ACUTE CARE * $ 263.00 A NEW YORK HOSPITAL-CORNELL MEDICAL CENTER WESTCHESTER DIVISION PSYCHIATRIC CARE * $ 259.00 ALL INCLUSIVE NORTHERN WESTCHESTER HOSPITAL INPATIENT ACUTE CARE * $ 290.00 A,C PEEKSKILL HOSPITAL INPATIENT ACUTE CARE * $ 230.00 A,C PHELPS MEMORIAL HOSPITAL ASSOCIATION INPATIENT ACUTE CARE * $ 276.00 A ST AGNES HOSPITAL INPATIENT ACUTE CARE * $ 268.00 A ST JOHNS RIVERSIDE HOSPITAL INPATIENT ACUTE CARE * $ 264.00 A ST JOSEPHS HOSPITAL YONKERS INPATIENT ACUTE CARE * $ 298.00 A, OTHER: EMG ST VINCENTS HOSP AND MEDICAL CTR OF NY WESTCHESTER BRANCH PSYCHIATRIC CARE * $ 217.00 A UNITED HOSPITAL INPATIENT ACUTE CARE * $ 247.00 A WESTCHESTER COUNTY MEDICAL CENTER INPATIENT ACUTE CARE $ 297.00 A,C WHITE PLAINS HOSPITAL MEDICAL CENTER INPATIENT ACUTE CARE * $ 262.00 A YONKERS GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 244.00 A,C YONKERS PROFESSIONAL HOSPITAL INPATIENT ACUTE CARE * $ 177.00 A A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE LONG ISLAND REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include Long Island region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: NASSAU CENTRAL GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 247.00 A COMMUNITY HOSPITAL AT GLEN COVE INPATIENT ACUTE CARE * $ 258.00 A FRANKLIN GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 238.00 A FREEPORT HOSPITAL PSYCHIATRIC CARE * $ 135.00 ALL INCLUSIVE HEMPSTEAD GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 273.00 A,C LONG BEACH MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 207.00 A LYDIA E HALL HOSPITAL INPATIENT ACUTE CARE * $ 265.00 A, OTHER: NUCLEAR MEDICINE MANHASSET MEDICAL CENTER HOSPITAL INPATIENT ACUTE CARE * $ 199.00 A MASSAPEQUA GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 278.00 A,C MERCY HOSPITAL OF ROCKVILLE CENTER INPATIENT ACUTE CARE * $ 235.00 A MID-ISLAND HOSPITAL INPATIENT ACUTE CARE * $ 254.00 A,C NASSAU COUNTY MEDICAL CENTER EAST MEADOW DIV INPATIENT ACUTE CARE * $ 401.00 ALL INCLUSIVE NASSAU HOSPITAL INPATIENT ACUTE CARE * $ 251.00 A,C NORTH SHORE UNIVERSITY HOSPITAL INPATIENT ACUTE CARE * $ 342.00 A SOUTH NASSAU COMMUNITIES HOSPITAL INPATIENT ACUTE CARE * $ 207.00 A ST FRANCIS HOSPITAL OF ROSLYN INPATIENT ACUTE CARE * $ 419.00 A,C SYOSSET HOSPITAL INPATIENT ACUTE CARE * $ 242.00 A, OTHER: NUCLEAR MEDICINE SUFFOLK BROOKHAVEN MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 257.00 A,C BRUNSWICK HOSPITAL CENTER INC INPATIENT ACUTE CARE * $ 269.00 A,C, OTHER: EKG, EEG, ELECTROMYOGRAPHY, NUCLEAR SCANS PSYCHIATRIC CARE * $ 170.00 A,C REHABILITATION * $ 276.00 A,C CENTRAL SUFFOLK HOSPITAL ASSOCIATION INPATIENT ACUTE CARE * $ 216.00 A EASTERN LONG ISLAND HOSPITAL INPATIENT ACUTE CARE * $ 252.00 A GOOD SAMARITAN HOSPITAL OF WEST ISLIP INPATIENT ACUTE CARE * $ 221.00 A HUNTINGTON HOSPITAL INPATIENT ACUTE CARE * $ 214.00 A, OTHER: RENAL DIALYSIS, CHEMOTHERAPY, RESPIRATORY THERAPY SUFFOLK JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON NEW YORK INC INPATIENT ACUTE CARE * $ 219.00 C SMITHTOWN GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 210.00 A SOUTH OAKS HOSPITAL PSYCHIATRIC CARE * $ 178.00 A,C SOUTHAMPTON HOSPITAL INPATIENT ACUTE CARE * $ 253.00 A SOUTHSIDE HOSPITAL INPATIENT ACUTE CARE * $ 274.00 A ST CHARLES HOSPITAL INPATIENT ACUTE CARE * $ 250.00 A ST JOHNS EPISCOPAL HOSPITAL SMITHTOWN INPATIENT ACUTE CARE * $ 271.00 A UNIVERSITY HOSPITAL OF STONY BROOK INPATIENT ACUTE CARE ** $ 456.00 ALL INCLUSIVE Effective 1/1/80 - 12/31/80 A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 ** Rate and Exclusions effective 1/1/80 thru 12/31/80 WORKERS' COMPENSATION HOSPITAL RATE SCHEDULE NEW YORK CITY REGION EFFECTIVE 07/01/80 - 12/31/80 This header cell was originally an empty cell. The contents of this column include New York City region counties and medical entities in those counties that provided Inpatient Acute Care when this Circular Letter was effective. DAILY RATE EXCLUSIONS: ASTORIA GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 207.00 A, OTHER: EEG, NUCLEAR MEDICINE BAPTIST HOSPITAL OF NEW YORK INPATIENT ACUTE CARE * $ 233.00 A BETH ISRAEL MEDICAL CENTER INPATIENT ACUTE CARE * $ 395.00 A BOOTH MEMORIAL MEDICAL CENTER INPATIENT ACUTE CARE * $ 309.00 A BOULEVARD HOSPITAL INPATIENT ACUTE CARE * $ 190.00 A BRONX-LEBANON HOSPITAL CENTER - FULTON DIVISION INPATIENT ACUTE CARE * $ 381.00 A,C BROOKDALE HOSPITAL MEDICAL CENTER INPATIENT ACUTE CARE * $ 375.00 A,C BROOKLYN HOSPITAL INPATIENT ACUTE CARE $ 286.00 A CABRINI HEALTH CARE CTR INPATIENT ACUTE CARE * $ 317.00 A,C, OTHER: EEG, EKG, SONOGRAPHY CALEDONIAN HOSPITAL OF THE CITY OF NY INPATIENT ACUTE CARE * $ 217.00 A CALVARY HOSPITAL INPATIENT ACUTE CARE * $ 332.00 ALL INCLUSIVE CATHOLIC MEDICAL CENTER INPATIENT ACUTE CARE * $ 356.00 ALL INCLUSIVE CMC ST JOHN'S QUEENS DIV INPATIENT ACUTE CARE * $ 356.00 A COMMUNITY HOSPITAL OF BROOKLYN INC. INPATIENT ACUTE CARE * $ 180.00 A, NUCLEAR MEDICINE, ULTRASOUND DEEPDALE GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 212.00 A,C DOCTORS HOSPITAL INC INPATIENT ACUTE CARE * $ 235.00 A,C DOCTORS HOSPITAL OF STATEN ISLAND INPATIENT ACUTE CARE * $ 214.00 A FLATBUSH GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 208.00 A FLUSHING HOSPITAL AND MEDICAL CENTER INPATIENT ACUTE CARE * $ 267.00 A GRACIE SQUARE GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 229.00 ALL INCLUSIVE PSYCHIATRIC CARE * $ 157.00 ALL INCLUSIVE H I P HOSPITAL INC. INPATIENT ACUTE CARE $ 257.00 A HILLCREST GENERAL HOSPITAL - GHI INPATIENT ACUTE CARE $ 245.00 A HOSPITAL FOR JOINT DISEASES AND MEDICAL CENTER ORTHOPEDIC INSTI INPATIENT ACUTE CARE * $ 497.00 A,C HOSPITAL FOR SPECIAL SURGERY RATE EXCLUSIONS: INPATIENT ACUTE CARE * $ 366.00 A INSTITUTE OF REHAB MEDICINE NY UNIVERSITY REHABILITATION * $ 307.00 A,C,D JAMAICA HOSPITAL INPATIENT ACUTE CARE * $ 273.00 A JEWISH HOSPITAL AND MEDICAL CENTER OF BROOKLYN INPATIENT ACUTE CARE * $ 311.00 A JEWISH MEMORIAL HOSPITAL INPATIENT ACUTE CARE * $ 235.00 A JOINT DISEASES NORTH GENERAL HOSPITAL INPATIENT ACUTE CARE $ 239.00 A KINGS HIGHWAY HOSPITAL INPATIENT ACUTE CARE * $ 215.00 A,C, OTHER: CARDIOLOGY, SONOGRAPHY KINGSBROOK JEWISH MEDICAL CENTER INPATIENT ACUTE CARE * $ 304.00 A LENOX HILL HOSPITAL INPATIENT ACUTE CARE * $ 336.00 A LEROY HOSPITAL INPATIENT ACUTE CARE * $ 222.00 A LONG ISLAND COLLEGE HOSPITAL INPATIENT ACUTE CARE $ 319.00 A LONG ISLAND JEWISH-HILLSIDE MED CTR INPATIENT ACUTE CARE * $ 404.00 A LUTHERAN MEDICAL CENTER INPATIENT ACUTE CARE * $ 350.00 A MAIMONIDES MEDICAL CENTER INPATIENT ACUTE CARE * $ 320.00 A MANHATTAN EYE EAR AND THROAT HOSPITAL INPATIENT ACUTE CARE * $ 325.00 A MEDICAL ARTS CENTER HOSPITAL INPATIENT ACUTE CARE * $ 212.00 A,C MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES INPATIENT ACUTE CARE * $ 564.00 ALL INCLUSIVE METHODIST HOSPITAL OF BROOKLYN INPATIENT ACUTE CARE * $ 296.00 A, OTHER: PHYSIATRY MISERICORDIA HOSPITAL MEDICAL CENTER INPATIENT ACUTE CARE $ 230.00 A,D, OTHER: AMBULANCE MONTEFIORE HOSPITAL & MEDICAL CENTER INPATIENT ACUTE CARE * $ 431.00 A MOUNT SINAI HOSPITAL INPATIENT ACUTE CARE * $ 404.00 A,C NY EYE AND EAR INFIRMARY INPATIENT ACUTE CARE * $ 275.00 A NEW YORK HOSPITAL AND PAYNE WHITNEY PSYCHIATRIC CLINIC INPATIENT ACUTE CARE * $ 399.00 A NY INFIRMARY BEEKMAN DOWNTOWN HOSPITAL INPATIENT ACUTE CARE * $ 313.00 A NY UNIVERSITY MEDICAL CENTER INPATIENT ACUTE CARE * $ 350.00 A,C OSTEOPATHIC HOSPITAL AND CLINIC INPATIENT ACUTE CARE $ 245.00 A PARKWAY HOSPITAL INPATIENT ACUTE CARE * $ 233.00 A,C PARSONS HOSPITAL INPATIENT ACUTE CARE * $ 183.00 A,C PELHAM BAY GENERAL HOSPITAL INPATIENT ACUTE CARE * $ 199.00 A,B,C, OTHER: EKG, EEG PENINSULA HOSPITAL CENTER INPATIENT ACUTE CARE * $ 229.00 A,B PHYSICIANS HOSPITAL INPATIENT ACUTE CARE * $ 221.00 A PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK INPATIENT ACUTE CARE * $ 414.00 A,B PROSPECT HOSPITAL INPATIENT ACUTE CARE * $ 180.00 A RICHMOND MEMORIAL HOSPITAL AND HEALTH CENTER INPATIENT ACUTE CARE * $ 267.00 A ROCKEFELLER UNIVERSITY HOSPITAL INPATIENT ACUTE CARE $ .00 ALL INCLUSIVE ST BARNABAS HOSPITAL INPATIENT ACUTE CARE * $ 288.00 ALL INCLUSIVE ST CLARES HOSPITAL AND HEALTH CENTER INPATIENT ACUTE CARE $ 246.00 A ST ELIZABETHS DIVISION OF ST CLARES HOSPITAL AND HEALTH CENTER INPATIENT ACUTE CARE $ 246.00 A ST JOHNS EPISCOPAL HOSPITAL INPATIENT ACUTE CARE * $ 271.00 A ST JOHNS EPISCOPAL HOSPITAL - SO SHORE DIV INPATIENT ACUTE CARE * $ 271.00 A ST LUKES - ROOSEVELT HOSPITAL CENTER INPATIENT ACUTE CARE * $ 410.00 A DETOXIFICATION UNIT * $ 91.00 A ST MARYS HOSPITAL OF BROOKLYN INPATIENT ACUTE CARE * $ 354.00 ALL INCLUSIVE ST VINCENTS HOSPITAL AND MEDICAL CENTER OF NY INPATIENT ACUTE CARE $ 315.00 A ST VINCENTS MEDICAL CENTER OF RICHMOND INPATIENT ACUTE CARE * $ 298.00 ALL INCLUSIVE STATE UNIVERSITY HOSPITAL DOWNSTATE MEDICAL CENTER INPATIENT ACUTE CARE * $ 287.00 A STATEN ISLAND HOSPITAL INPATIENT ACUTE CARE * $ 305.00 A TERRACE HEIGHTS HOSPITAL INPATIENT ACUTE CARE * $ 213.00 A UNION HOSPITAL OF THE BRONX INPATIENT ACUTE CARE * $ 180.00 A,C VICTORY MEMORIAL HOSPITAL INPATIENT ACUTE CARE $ 192.00 A WESTCHESTER SQUARE HOSPITAL INPATIENT ACUTE CARE * $ 178.00 A,C, OTHER: NUCLEAR MEDICINE WYCKOFF HEIGHTS HOSPITAL INPATIENT ACUTE CARE * $ 240.00 A,C, OTHER: PFT, EKG, EEG HEALTH AND HOSPITAL CORPORATION BELLEVUE HOSPITAL CENTER INPATIENT ACUTE CARE $ 298.00 ALL INCLUSIVE EXCLUDING PHYSICIANS $ 288.00 BIRD S COLER MEMORIAL HOSPITAL AND HOME INPATIENT ACUTE CARE $ 229.00 ALL INCLUSIVE BRONX MUNICIPAL HOSPITAL CENTER INPATIENT ACUTE CARE $ 311.00 ALL INCLUSIVE CITY HOSPITAL CENTER AT ELMHURST INPATIENT ACUTE CARE $ 289.00 ALL INCLUSIVE CONEY ISLAND HOSPITAL INPATIENT ACUTE CARE $ 309.00 ALL INCLUSIVE EXCLUDING PHYSICIANS 301.00 CUMBERLAND HOSPITAL INPATIENT ACUTE CARE $ 336.00 ALL INCLUSIVE GOLDWATER MEMORIAL HOSPITAL INPATIENT ACUTE CARE $ 184.00 ALL INCLUSIVE GREENPOINT HOSPITAL INPATIENT ACUTE CARE $ 323.00 ALL INCLUSIVE HARLEM HOSPITAL CENTER INPATIENT ACUTE CARE $ 288.00 ALL INCLUSIVE EXCLUDING PHYSICIANS 272.00 KINGS COUNTY HOSPITAL CENTER INPATIENT ACUTE CARE $ 292.00 ALL INCLUSIVE LINCOLN MEDICAL & MENTAL HEALTH CENTER INPATIENT ACUTE CARE $ 382.00 ALL INCLUSIVE METROPOLITAN HOSPITAL CENTER INPATIENT ACUTE CARE $ 374.00 ALL INCLUSIVE EXCLUDING PHYSICIANS 358.00 NORTH CENTRAL BRONX HOSPITAL INPATIENT ACUTE CARE $ 417.00 ALL INCLUSIVE QUEENS HOSPITAL CENTER INPATIENT ACUTE CARE $ 290.00 ALL INCLUSIVE SYDENHAM HOSPITAL INPATIENT ACUTE CARE $ 250.00 ALL INCLUSIVE A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST * Revised Rate and Exclusions effective 7/1/80 thru 12/31/80 State of New York, Workers' Compensation Board, Office of the Chairman TO: Insurance Carriers and Self-Insurers Providing Benefits Under the Workers" Compensation Law and Volunteer Firemen's Benefit Law Subject: Workers' Compensation Hospital Fee Schedule Effective January 1, 1980 - Baptist Medical Center of New York (formerly Interboro Hospital) Baptist Hospital of New York and Interboro Hospital have merged into a single entity under the name of Baptist Medical Center of New York, which is located at the Interboro site. For the period 2/1/80 - 12/31/80, the Workers" Compensation rate of $ 221.00, promulgated for Interboro Hospital, should be used as an interim rate of reimbursement for the Baptist Medical Center. [SIGNATURE] Chairman