daisyBill’s Calculator is comprised of six separate Fee Schedules and five separate Calculators. Each Calculator references specific Fee Schedule or Fee Schedules. Choosing the correct Calculator is vital to ensuring accurate reimbursements.
Here’s how it’s done.
For services provided by a Physician, Non-Physician Practitioner, or Clinical Social Worker, the Physicians Services Fee Schedule determines reimbursements, including Billing Ground Rules, and NCCI edits (CCI and MUE) for the following types of services:
- Physician Dispensed DME
- Physician Dispensed Pharmaceuticals
- California Specific Reporting Codes
- Medical Treatment
The Physician Services Fee Schedule provides accurate reimbursement for dates of service 2005 to present. Reimbursement provided by the Physician Services Fee Schedule is determined per:
- CCR § 9789.12.1 Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services – For Services Rendered On or After January 1, 2014
- California Worker’s compensation final regulations Medical legal fee schedule
- Regulations effective Jan. 14, 2005 (Section 9789.11) and Table A 9789.11
For help using the Physician Services Fee Schedule Calculator see the Help Article: Physician Services Calculator.
The Pharmacy Fee Schedule determines reimbursement for pharmaceuticals and pharmacy services per CCR § 9789.40 Pharmacy. For physician dispensed pharmaceuticals, use the Physician Services Fee Schedule.
daisyBill’s Pharmacy OMFS Calculator maintains NDC reimbursement information for all dates of service March 2007 through present dates.
The Pathology Fee Schedule determines reimbursement for pathology and clinical laboratory services per CCR § 9789.50. Pathology and Laboratory.
For help using the Pathology Fee Schedule Calculator see the Help Article: Pathology Calculator.
The DMEPOS Fee Schedule determines reimbursement for durable medical equipment, prosthetics, orthotics and supplies per CCR § 9789.60. Durable Medical Equipment, Prosthetics, Orthotics, Supplies.
For help using the DMEPOS Fee Schedule Calculator see the Help Article: DMEPOS Calculator.
The Copy Service Fee Schedule determines reimbursement for copy related expenses per CCR § 9981- Bills for Copy Services. This fee schedule became effective 7/1/2015.
For help using the Copy Service Fee Schedule Calculator see the Help Article: Copy Service Calculator.
The Hospital Outpatient Departments and Ambulatory Surgical Centers Fee schedule determines facility reimbursement for outpatient services performed in an outpatient hospital or Ambulatory Surgical Center (ASC) setting per CCR 9789.33 Hospital Outpatient Departments and Ambulatory Surgical Centers
Fee Schedule — Determination of Maximum Reasonable Fee.
The Outpatient ASC calculator can provider reimbursement for dates of service 12/15/2016 to present.
For help using the Outpatient ASC Calculator see the Help Article: Outpatient ASC Calculator.
We hope that clarifies things!