§ 9789.12.8 Status Codes

Summary

Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adapted Medicare CPT/HCPCS Status Codes to further provide reimbursement information for various Procedure Codes.  

The assigned status code determines the procedure code’s payment status.

Below is a list of the DWC’s current Status Codes and descriptions.

A: Active Code. These codes are paid separately under the physician fee schedule. There will be RVUs for codes with this status.

B: Bundled Code. Payment for covered services are always bundled into payment for other services not specified. If RVUs are shown, they are not used for payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient).

C: If payable, these codes will be paid “By Report”, generally following review of documentation such as an operative report.

E: If payable: (a) HCPCS codes beginning with “J” or “P”, maximum fee is determined according section 9789.13.2.  (b) Other codes are paid under the applicable fee schedule contained in Section 9789.30-9789.70, or if none of those schedules is applicable the code is payable “By Report.”

I: Except as otherwise provided, not valid code for workers' compensation physician billing. See section 9789.12.3.

J: Anesthesia Services. The intent of this value is to facilitate the identification of anesthesia services. There are no RVUs and no payment amounts for these codes in the National Physician Fee Schedule Relative Value File. Instead, the Anesthesia Base Units file is to be used to determine the base units for these codes.

M: Measurement codes. Used for reporting purposes only.

N: If payable, these CPT codes are paid using the listed RVUs; but if no RVUs are listed, then By Report. See section 9789.12.3.

P: Bundled/Excluded Codes. There are no RVUs and no payment amounts for these services. No separate payment should be made for them under the fee schedule. If the item or service is covered as incident to a physician service and is provided on the same day as a physician service, payment for it is bundled into the payment for the physician service to which it is incident. (An example is an elastic bandage furnished by a physician incident to physician service.) -If the item or service is covered as other than incident to a physician Service, it is excluded from the fee schedule (i.e., colostomy supplies) and should be paid under the other portions of the fee schedule.

R: If payable, these codes will be paid pursuant to section 9789.12.3.

T: Injections. There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made.

X: No RVUS or payment amounts are shown for these codes. If payable, these codes are paid under the applicable fee schedule contained in Sections 9789.30 - 9789.70, or if none of those schedules is applicable the code is payable “By Report.”  (Examples of services payable under another fee schedule are ambulance services and clinical diagnostic laboratory services.)

Is 99080 a valid and billable code?

Many people ask about using report code 99080 to bill for reports that do not fall under any of the California Specific Code definitions. While 99080 is a valid code, it is a status code B which means it’s bundled and not payable.

California Code of Regulations (CCR)

§ 9789.12.8 Status Codes

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Resources

Technology is your friend when it comes to calculating correct fee schedule reimbursements. For every procedure code calculated, the DaisyBill OMFS Calculator automatically provides the status code and the status code definition.

 DaisyBill OMFS Calculator

Sign up for a free trial of the DaisyBill OMFS Calculator and instantly start billing easier.

Try the DaisyBill OMFS Calculator

Was this article helpful?

About Us

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.

Read more

Search results for: