For physician services rendered from July 2004 through December 31st, 2013, regulations § 9789.10 and § 9789.11 affected reimbursements. After January 1st, 2014, the physician fee schedule changed to the RBRVS system. Here’s how to calculate reimbursements for the affected dates of service.
For services rendered before January 1st, 2014, section 9789.11 established the fee due for medical services provided by both physicians and non physicians. The DWC published these fees in Table A.
FAQ: How do I find reimbursements for services rendered through December 31st, 2013?
To download Table A to locate the OMFS maximum reimbursement for services rendered through December 31st, 2013, follow the instructions below.
Step 1. Download Table A
Step 2. Find Procedure Code OMFS Maximum
When California passed SB 863, the calculations changed. For all dates of service rendered on or after January 1st, 2014, the DWC implemented an RBRVU-based Physician Fee Schedule.
To learn how to calculate reimbursements for services rendered after January 1st, 2014, refer to the regulations. Title 8, California Code of Regulations § 9789.12.2 sets forth the formulas for services other than anesthesia. Title 8, California Code of Regulations § 9789.18.1 sets forth the formulas for anesthesia services.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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