Frequently Asked Questions
§ 9789.13.2 Physician-Administered Drugs, Biologicals, Vaccines, Blood Products
For medical services rendered on and after January 1st, 2014, the RBRVU Physician Services 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.
The regulation determining reimbursement for physician administered drugs, biologicals and blood products is one of the most complicated regulations.
Physician-administered drugs, biologicals, vaccines, or blood products are separately payable.
- For vaccines this regulation clearly states that both the vaccine service and the vaccine drug are reimbursable. The regulation instructs billing both the vaccine procedure code and the NDC for the vaccine product.
- For other physician-administered drugs, both the drug administratration service and the drug products are reimbursable. The regulation instructs billing both the procedure code for the service and the J code for the drug product.
- If a J code does not exist for the drug product, the regulation instructs billing the drug product using the NDC number associated with the drug product.
Medi-Cal Rates File
Per section 9789.13.2, the California Medi-Cal Rates file determines the reimbursement for J-codes. The Physician Fee Schedule adopts a new Medi-Cal file on the 15th of every month.
How do I bill for chemotherapy injections and radiopharmaceuticals?
Section 9789.13.2 explains the regulations for physician-administered drugs, biologicals, vaccines, or blood products. All physician-administered drugs, biologicals, vaccines, or blood products are separately payable, including cancer chemotherapy injection.
Physician-administered radiopharmaceuticals, components for specific procedures (listed below) are separately payable when the TC is payable.
For more information, refer to the regulation linked below.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
Technology is your friend when it comes to calculating correct fee schedule reimbursements. DaisyBill’s OMFS Calculator makes determining accurate reimbursements quick and hassle-free for current AND past dates of service.
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.