§ 9789.17.1 Radiology Diagnostic Imaging Multiple Procedures

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.

Radiology reimbursement is based on the values of the professional and technical components for each radiology procedure code. For multiple radiology procedures, cascading reductions apply separately to these components.

Example: Procedure Codes 70544 and 70553

DaisyBill OMFS Calculator

For the Technical Component (TC):

  • The radiology procedure code with the highest technical component value is paid 100% of the technical value.
  • The value of the technical component for the remaining radiology procedure codes is reduced to 50%.

Billing Ground Rules: Technical Component, Professional Component

For the Professional Component:

  • The radiology procedure code with the highest professional component value is paid 100% of the professional value.
  • The value of the professional component for the remaining radiology procedures codes is reduced to 75%.

California Code of Regulations (CCR)

§9789.17.1 Radiology Diagnostic Imaging Multiple Procedures

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Resources

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.

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: