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 70%.
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 50%.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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