ASK A QUESTION
Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services – For Services Rendered On or After January 1, 2014

For medical services rendered in California on and after January 1st, 2014, but before February 16, 2015, 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:

  1. services or goods are bundled, and/or
  2. it is otherwise specified in the Physician Fee Schedule.

California Code of Regulations (CCR)

§ 9789.12.1 Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services – For Services Rendered On or After January 1, 2014

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Solution

Technology is your friend when it comes to calculating correct fee schedule reimbursements.

Thousands of workers’ comp professionals use DaisyBill’s Revenue Cycle Management software to compliantly process electronic bills. To learn more, schedule a no-pressure demo with one of our billing experts.

REQUEST DEMO

Was this article helpful?

Search results for: