New York workers’ comp & no-fault DME
Back braces for workers’ comp & no-fault claims
A lumbar or back brace your treating provider prescribed after a work injury or car accident — handled under your New York claim, from the prescription through delivery and fitting.
Your treating provider decides what’s medically necessary; this page explains the process.
Does workers’ comp or no-fault cover a back brace in New York?
Yes — when your treating provider prescribes a back brace for a work injury or motor-vehicle accident, New York workers’ comp or no-fault can cover it. A prescription is always required; some workers’ comp braces also need prior authorization. Patients, attorneys, treating providers, and adjusters may use the online form. Providers may also fax or email referrals.
Providers may also fax (973) 846-7077 or email referral@citydme.com. Provider referrals are not accepted by phone.
- Rx-first
Prescription confirmed before fulfillment
- Next-day
Referral review
- WC + NF
New York claim paths we handle daily
- NYC + LI
Brooklyn, Queens, Manhattan, the Bronx, Staten Island, and Long Island
What back-brace situations are covered?
Coverage follows the claim and the prescription, not a catalog. The common paths we handle in New York:
Work injuries (workers’ comp)
Lumbar or lumbosacral bracing prescribed after an on-the-job back injury, billed to the workers’ compensation carrier on the claim.
Motor-vehicle accidents (no-fault)
Back bracing prescribed after a car accident, billed to the no-fault (auto) carrier once the claim details and assignment of benefits are in place.
Whatever the prescription specifies
We fill the brace the treating provider ordered.
What prescription and documents do you need for a back brace?
A prescription from the treating provider is always required. For workers’ comp, some braces also need a prior authorization (PAR) — submitted through OnBoard by the Board-authorized prescribing provider, not the DME supplier — and we flag when one is needed. For no-fault, we collect the claim number, carrier, accident date, and assignment-of-benefits paperwork so the carrier can be billed directly.
Does CityDME submit the workers’ comp prior authorization?
No. When a workers’ comp brace requires prior authorization, the PAR is submitted through OnBoard by the Board-authorized prescribing provider. DME suppliers are not eligible to submit PARs. CityDME informs the prescribing office when a PAR is needed.
How do I send a back-brace referral?
Patients, attorneys, treating providers, and adjusters can use our referral form. Providers may also send the prescription and claim details by fax to (973) 846-7077 or by email to referral@citydme.com. CityDME runs a completeness review the next business day and informs the sender if anything is missing.
- 1. Send the prescription. Include the claim type — workers’ comp or no-fault — and whatever claim details you have.
- 2. We review it the next business day. We check the order for completeness and flag a PAR if the item needs one.
- 3. We deliver and fit. Once the documentation is complete, we schedule delivery, setup, and fitting.
Is fitting and delivery included, or an extra charge?
Under the New York fee-schedule reimbursement for a covered brace, delivery, setup, and any necessary fittings and adjustments are part of the service — not a separate add-on. $0 out of pocket where your claim applies and documentation is complete.
Which New York rules apply?
Back bracing is billed under New York’s claim rules — the workers’ compensation DME fee schedule, or the no-fault (Regulation 68) fee schedule for auto claims. A prescription is always required, patient billing for covered services is limited, and for workers’ comp any prior authorization is provider-submitted through OnBoard. The plain-language explainers live here:
General equipment-support questions? Call (973) 850-3121.