Regulation 9789.60 states that DMEPOS reimbursements shall not exceed one hundred twenty (120) percent of the rate set forth in the CMS' (which is also known as Medicare) Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) Fee Schedule for California.
For DME products the reimbursement is a simple calculation of the Medicare reimbursement multiplied by 120%. This 120% calculation is true ONLY for two types of reimbursements: DMEPOS and Pathology. This 120% rule does not apply to the Physician Services Fee Schedule.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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