Frequently Asked Questions
§ 9789.12.4 “By Report” - Reimbursement for Unlisted Procedures / Procedures Lacking RBRVUs
Calculating OMFS reimbursement is a complex process that involves multiple tables, formulas and Billing Ground Rules. The OMFS Calculator takes into consideration all of these factors when providing OMFS reimbursement.
The DWC mandates that an unlisted procedure code is paid “By Report”, following review of documentation. The necessary conditions for billing “By Report” include:
- The service was reasonable and necessary to cure or relieve from the effects of the industrial injury or illness.
- The bill includes an adequate description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
If a California workers’ comp fee schedule designates the reimbursement amount for a procedure code entered on a Bill as ‘By Report’ (BR), DaisyBill’s scrub prevents bill submission until a reimbursement amount is entered for the procedure code.
Sign up for a free trial of the DaisyBill OMFS Calculator and instantly start billing easier.
Was this article helpful?
DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.
Drop us a line with any news you would like us to share or any issue that concerns you.