New York workers’ compensation
Workers’ comp DME in New York, explained
What the state covers for durable medical equipment after a work injury — the fee schedule, prior authorization, and who pays — in plain language, from a Brooklyn desk that handles these claims daily.
The short answer
Does NY workers’ comp cover DME like braces or a CPM machine?
Often, yes. New York workers’ comp covers durable medical equipment that a treating provider prescribes for a work injury, priced by the state WC DME fee schedule. A prescription is required, and some items need prior authorization. Eligible patients pay $0 out of pocket where your claim applies and documentation is complete.
What DME does New York workers’ comp cover?
New York prices workers’ comp durable medical equipment with the Official New York Workers’ Compensation DME Fee Schedule. The schedule lists covered equipment item by item, with a maximum purchase price, a weekly rental price, and whether prior authorization is required.
When an item is covered, the fee-schedule reimbursement already includes delivery, setup, and the fittings and adjustments the equipment needs — and monthly rentals include routine maintenance and repair. A prescription from your treating provider is always required before equipment is supplied.
This is general information about the New York process, not legal advice.
- 4th Ed.
Official NY workers’ comp DME fee schedule now in force
- 2024
Effective June 28, 2024 — the current fee schedule
Beyond what’s shown here, the desk regularly supplies cold therapy units, compression devices, and ankle-foot supports — whatever the prescription calls for.
How workers’ comp DME coverage works
The facts that shape a New York workers’ comp DME claim, and how the desk keeps a referral moving.
- 4th Ed.
NY WC DME fee schedule, effective June 28, 2024
- 45 days
Insurer to pay supplier claims unless disputed
- Rx-first
Prescription and claim reviewed before fulfillment
- 5
Boroughs served from Brooklyn
Do I need prior authorization, and who submits the PAR?
Not every item needs prior authorization. A prior authorization request (PAR) is required only when the fee schedule marks the item as PAR-required, or when the item is not listed on the schedule at all. If an item is on the schedule and is not flagged, it can be billed at the fee-schedule rate without a PAR — and CityDME does not submit workers’ comp PARs; the request always runs through your prescriber.
When a PAR is required
Only when the fee schedule marks the item as PAR-required, or when the item is not listed on the schedule at all.
Who submits it
The Board-authorized provider who ordered or prescribed the equipment, through OnBoard. DME suppliers are not eligible to submit PARs.
What CityDME does
We flag when a PAR is needed and tell your prescriber exactly what documentation is missing — before anything holds up the order.
Will I pay out of pocket for workers’ comp DME?
For covered, eligible equipment, New York’s rules direct that supplier claims be paid within 45 calendar days of receipt unless the insurer disputes them, with written notice if a claim is not paid. We review the prescription and claim details before fulfillment, so if there is a coverage or documentation problem, we explain the issue up front rather than after the equipment ships.
The supplier bills the workers’ comp insurer — not you.
- $0
Out of pocket where the claim applies and documentation is complete
- 45 days
Insurer payment clock for supplier claims unless disputed
Can I choose my own DME supplier?
Usually, yes. Any DME supplier that provides equipment to injured workers in New York must be enrolled through the New York State Department of Health Medicaid program. What changes is who directs the choice:
| Arrangement | Who picks the supplier | Timing rule |
|---|---|---|
| PPO arrangement | The insurer may direct you to a specific supplier | Equipment assembled and available, or delivered, within 48 hours |
| No PPO arrangement | You may choose any Medicaid-enrolled DME supplier you prefer | — |
Send a workers’ comp DME referral
Patients, attorneys, providers, and adjusters can start one here. Send the patient’s details, the prescription, and the claim information, and the Brooklyn desk reviews it the next business day.