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 70554 and 70553

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%.

For the Professional Component for Dates of Service on or after March 1, 2017:

• 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 95%.

For the Professional Component for Dates of Service prior to March 1, 2017:

• 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 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.

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