For medical services rendered on and after January 1st, 2014, the RBRVU Physician Fee schedule consists of 48 Regulations, including 40 fee-affecting regulations. Knowing and understanding these additional fee-affecting regulations is critical to determining the correct reimbursement for services.
Section 9789.12.1 is the very first section in the Physician Fee Schedule. This section provides guidelines for using the Physician Fee Schedule.
Section 9789.12.1(a) mandates that the Physician Fee Schedule does not govern fees for services covered by contracts such fees as permitted by Labor Code section 5307.11.
Section 9789.12.1(b) states that the Physician Fee Schedule is used to determine maximum fees for physicians and non-physician practitioners, except:
- Only physicians use Evaluation and management (E&M codes) - See Labor Code § 3209.3
- Only licensed Doctors of Osteopathy and Medical Doctors use Osteopathic Manipulation Codes
Lastly, section 9789.12.1(c) mandates that physicians and non-physician practitioners must use other sections of the OMFS to determine maximum fees for services not covered by the Physician Fee Schedule, such as pharmaceuticals (section 9789.40), pathology and clinical laboratory (section 9789.50) and DMEPOS (section 9789.60). This does not apply when:
- services or goods are bundled, and/or
- it is otherwise specified in the Physician Fee Schedule.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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