Summary

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.

Medi-Cal Rates File:

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)

§ 9789.13.2 Physician-Dispensed Drugs

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Solution

Technology is your friend when it comes to calculating correct fee schedule reimbursements. DaisyBill’s Work Comp Wizard makes determining accurate reimbursements quick and hassle-free for current AND past dates of service.

Sign up for the DaisyBill Work Comp Wizard and instantly start billing easier. Click below for a FREE three day trial and start easy calculations today

Try the DaisyBill
OMFS Calculator