The workers’ comp Official Medical Fee Schedule reimburses durable medical equipment (DME) 120% of the amount allowed by Medicare for California.
To appeal workers' comp incorrectly reimbursed DME bills, DaisyBill suggests the following appeal reason:
“Pursuant to Labor Code 5307.1 and CCR Section 9789.60, the workers’ compensation DME maximum is 120% of the Medicare CMS rate for California.” For DME, a receipt is not required for reimbursement, with the exception of dangerous devices as defined by Labor Code section 5307.1
For reference, the DWC site states in its FAQ section:
This is an example from an SBR using DaisyBill's SBR Generator:
Remember: For an SBR, the Amount in Dispute should be the difference between the fee schedule amount effective on the date of service and the amount paid. The SBR-1 form does not require the fee schedule amount; instead, it requires the amount in the dispute which should be the expected amount minus the allowed amount.
California Labor Codes
California Code of Regulations (CCR)
§ 9789.60 Durable Medical Equipment, Prosthetics, Orthotics, Supplies
Division of Workers’ Compensation Websites
DWC Official Medical Fee Schedule
DaisyBill Solution
DaisyBill’s easy billing software guarantees that workers’ comp bills are always submitted compliantly. For more information about California’s workers’ comp electronic billing, book a demo and see how easily DaisyBill solves workers' comp billing problems.