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§ 9789.12.5 Conversion Factors

Summary

Calculating OMFS reimbursement is a complex process that involves multiple tables, formulas and Billing Ground Rules. DaisyBill integrates all of these factors into OMFS calculations with the OMFS Calculator.

To calculate the Base Maximum Fee, the current RBRVS-based fee schedule (effective January 1, 2014) requires the calculation of three separate components:

  1. Relative Value Units (RVUs)
  2. Average Statewide Geographic Adjustment Factors (GAFs)
  3. Conversion Factor (CF)

This article explains how to determine the Conversion Factor (CF).

Regulation 9789.19, which is the Update Table, provides the four new conversion factors effective as of April 1st, 2016. The four conversion factors are listed in the table below.

' Conversion Factors, California workers’ comp]

To calculate the base maximum fee, select the conversion factor that matches the type of HCPCS / Procedure Code.

  • Anesthesia Conversion Factor: $28.8003
  • Surgery Conversion Factor: $48.1743
  • Radiology Conversion Factor: $47.4332
  • Other Services Conversion Factor: $42.4361

Check the DWC website periodically, because conversion factors often change.

Why are there different conversion factors in section 9789.12.5 and section 9789.19?

Labor Code section 5307.1 requires a four year transition period between the old fee schedule and the fully implemented new schedule based upon the RBRVS.

Section 9789.12.5(b)(2) sets forth the temporary conversion factors during the four-year transition period before adjustment for inflation and the Medicare relative value scale adjustment.

Section 9789.19 (the Update Table) sets forth the conversion factors after adjustment for inflation and Medicare relative value scale adjustment. The conversion factors set forth in the Update Table are the correct conversion factors to use in calculating maximum fees.

California Code of Regulations (CCR)

§ 9789.12.5 Conversion Factors

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

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