Physical Therapy Billing in New York: No-Fault and Workers’ Comp
Physical therapy billing in New York depends on why the patient is in your chair. A car accident sends the bill to no-fault auto insurance, which expects proof of claim within 45 days of service. A work injury goes to workers’ compensation, which requires Board authorization, a referral and electronic billing. This guide shows how to route each visit and fix the denials that follow. For the wider picture, see our specialty medical billing guide.
| Key takeaways No-fault auto claims need proof of claim within 45 days of each service, and insurers owe payment within 30 days of receiving it.Workers’ comp requires Board authorization, a qualifying referral and electronic CMS-1500 billing.Many commercial insurers must pay or deny clean claims within 30 days if electronic and 45 days otherwise.Ask every patient at check-in whether the injury came from a car accident or work. |
Physical therapy billing in New York at a glance
The reason for the visit decides the payer. This table shows where each claim goes and which rule applies.
| Payer type | Where the claim goes | New York rule to track |
| No-fault auto (PIP) | The patient’s auto insurer | Proof of claim within 45 days of service; insurer pays within 30 days of receiving it |
| Workers’ compensation | The employer’s carrier | Board-authorized therapist, referral, Medical Treatment Guidelines, electronic CMS-1500 |
| Insured commercial plans | The insurer | Pay or deny in 30 days if electronic, 45 days otherwise; submit within 120 days of service |
| Medicare | The Medicare contractor | Federal rules apply, not New York deadlines |
Self-funded plans and contracted payers set their own limits in the contract and provider manual, so check yours.
In short: the no-fault clock starts at the date of service, while the insurer’s payment clock starts when it receives your proof of claim.
No-fault auto claims
New York no-fault covers medical care after a car accident regardless of fault. Under Insurance Law section 5106, benefits are overdue if not paid within 30 days after the claimant supplies proof, and overdue amounts bear interest at 2% per month.
The provider’s clock is shorter. Under 11 NYCRR 65-1.1, proof of claim is due within 45 days of each date of service, though a late claim may be excused for reasonable justification. Do not batch bills at the end of treatment, because every visit has its own 45-day clock.
Insurers can ask for more information. Under 11 NYCRR 65-3.5, the insurer has 15 business days to request verification after receiving a claim, so answer promptly and keep a dated record of what you sent. Capture the accident date and the auto insurer’s claim number at the first visit.
Workers’ compensation claims
The Workers’ Compensation Board sets the rules for therapists. According to the Board’s physical therapist page, therapists must be Board-authorized and treat on a referral from the treating physician, physician assistant, nurse practitioner or podiatrist. Care follows the Medical Treatment Guidelines (MTGs).
Bills and narratives go on the CMS-1500 through a Board-approved electronic submission partner. Treatment outside the MTGs needs prior authorization through the Board’s OnBoard system. Our guide to prior authorization tracking covers how to log and follow up on requests.
Chiropractors face similar Board authorization and MTG rules, and our chiropractic CPT codes guide covers their coding. For payment delays, see workers’ compensation billing delays.
In short: accident visits go to no-fault, work injuries to the carrier, and other visits route by plan type.
Commercial plans and Medicare
For insurers covered by Insurance Law section 3224-a, payment is due within 30 days of an electronic claim and 45 days of other claims. Late payments accrue interest at 12% a year or the state’s set rate if higher.
Providers generally must submit claims within 120 days of service. An insurer may reduce payment on a late claim by up to 25%, and for claims over 365 days old it may deny in full. The law has limits on which policies it covers, so confirm with your contracts.
Medicare follows federal rules. Therapy codes billed in timed units, covered by the eight-minute rule, are a frequent audit target.
Front-desk checklist before the patient leaves
Most New York denials are preventable at registration. Use this checklist.
- Ask why the patient is here: car accident, work injury or other.
- For an accident, record the accident date and the auto insurer’s claim number.
- For a work injury, record the employer, carrier, claim number and the referring provider.
- For everything else, confirm eligibility and plan type for the date of service.
- Check that treatment fits the MTGs, or start a prior authorization request.
- Send each claim after each visit and log the 45-day no-fault limit.
Common New York denials and fixes
Sample (fictional data): a patient is treated twelve times after a car accident, and the clinic bills the no-fault insurer once, on visit twelve. The first eleven visits are past 45 days. The clinic must now show reasonable justification for the delay.
| Problem | Likely cause | Fix and prevention |
| Late no-fault claim | Bills batched until treatment ends | Send proof of claim after each visit within 45 days. |
| No referral on file | Work injury care started without the referral | Get the referral before the first visit. |
| Rejected workers’ comp bill | Paper or non-approved submission | Use a Board-approved e-partner. |
| Treatment outside guidelines | No prior authorization request | File the request before treating. |
| Verification request ignored | No one tracks insurer letters | Assign an owner and answer in writing. |
For claims already denied, follow our step-by-step guide to appealing a denied medical claim.
Frequently asked questions
How long do I have to bill New York no-fault?
Under 11 NYCRR 65-1.1, proof of claim is due within 45 days of the date of service for each visit. A late claim may be excused if there is reasonable justification. The insurer then owes payment within 30 days of receiving proof, or benefits become overdue and accrue 2% monthly interest.
Do physical therapists need authorization for workers’ comp?
Yes. The Workers’ Compensation Board requires therapists to be Board-authorized, and treatment needs a referral from the treating physician, physician assistant, nurse practitioner or podiatrist. Care should follow the Medical Treatment Guidelines. Treatment outside the guidelines needs prior authorization through the Board’s OnBoard system.
How are workers’ comp bills submitted in New York?
Bills and narratives go on the CMS-1500 through a Board-approved electronic submission partner. The Board states that electronic CMS-1500 submission is mandatory, and it does not enforce payment of bills submitted any other way. Confirm your billing software or clearinghouse can submit through an approved partner.
How fast must New York insurers pay commercial claims?
For insurers covered by Insurance Law section 3224-a, payment is due within 30 days for electronic claims and 45 days for other claims. Late payments accrue interest, and providers generally have 120 days from service to submit. Contracts and self-funded plans may differ, so check your payer manual.
Getting physical therapy billing in New York under control
Physical therapy billing in New York rewards clinics that ask why the patient is here and watch the clock after each visit. EZMedPro is a US-based medical billing, coding, credentialing and revenue cycle management company with transparent reporting and no hidden fees. Results vary by practice.
You can review our billing, coding, credentialing and revenue cycle management services or talk with the team about your clinic.
Sources: New York Insurance Law sections 5106 and 3224-a (New York State Senate), 11 NYCRR 65-1.1 and 65-3.5, and the Workers’ Compensation Board physical therapist page. General information, not legal advice.
Frequently asked questions
How long do I have to bill New York no-fault?
Under 11 NYCRR 65-1.1, proof of claim is due within 45 days of the date of service for each visit. A late claim may be excused if there is reasonable justification. The insurer then owes payment within 30 days of receiving proof, or benefits become overdue and accrue 2% monthly interest.
Do physical therapists need authorization for workers’ comp?
Yes. The Workers’ Compensation Board requires therapists to be Board-authorized, and treatment needs a referral from the treating physician, physician assistant, nurse practitioner or podiatrist. Care should follow the Medical Treatment Guidelines. Treatment outside the guidelines needs prior authorization through the Board’s OnBoard system.
How are workers’ comp bills submitted in New York?
Bills and narratives go on the CMS-1500 through a Board-approved electronic submission partner. The Board states that electronic CMS-1500 submission is mandatory, and it does not enforce payment of bills submitted any other way. Confirm your billing software or clearinghouse can submit through an approved partner.
How fast must New York insurers pay commercial claims?
For insurers covered by Insurance Law section 3224-a, payment is due within 30 days for electronic claims and 45 days for other claims. Late payments accrue interest, and providers generally have 120 days from service to submit. Contracts and self-funded plans may differ, so check your payer manual.
Getting physical therapy billing in New York under control
Physical therapy billing in New York rewards clinics that ask why the patient is here and watch the clock after each visit. EZMedPro is a US-based medical billing, coding, credentialing and revenue cycle management company with transparent reporting and no hidden fees. Results vary by practice.
You can review our billing, coding, credentialing and revenue cycle management services or talk with the team about your clinic.
Sources: New York Insurance Law sections 5106 and 3224-a (New York State Senate), 11 NYCRR 65-1.1 and 65-3.5, and the Workers’ Compensation Board physical therapist page. General information, not legal advice.
