To use the Medical-Legal Calculator to calculate reimbursements for Medical-Legal Services, follow these instructions.
Step 1. Select ‘Medical-Legal’
Step 2. Enter ‘DOS’
An accurate OMFS reimbursement amount requires the Date of Service. OMFS reimbursement amounts are calculated using the fee schedule(s) in effect on the date the services were rendered. The Calculator stores historical reimbursement data for dates of service 2005 to present.
Step 3. Enter Place of Service Locality
For Dates of Service on or after January 1, 2019 California's fee schedule is calculated based on the location where services are rendered (Place of Service, CMS1500 Box 32).
Select County to provide the County where services were rendered. If you cannot find the County, select All Other Counties.
Or, enter the Zip Code of the Place of Service.
Step 4. Enter ‘Procedure Code’
California Medical-Legal Codes that describe services rendered.
Step 5. Optional: Enter ‘Modifiers’
Enter applicable Modifiers for the Procedure Code. Some Modifiers affect reimbursement calculations (referred to as ‘fee-affecting’ modifiers) or may affect Correct Coding Initiative (CCI) edits.
Step 6. Enter ‘Units’
Enter the number of Units to represent the quantity of the Procedure Code. Depending on the Procedure Code, a Unit might represent any of the following: number of report pages, a block of time, number of pills, etc.
Step 7. Optional: Enter ‘Payment Total’
Enter the reimbursement amount allowed by the claims administrator as reported on an explanation of review (EOR). This optional field defaults to $0. The Payment Total amount is used to calculate the Expected %.
Step 8. Optional: Repeat steps 6-9 for additional Procedure Codes
Step 9. Click ‘Calculate’
Step 10. View the calculations
For more information on calculations see the Help Article: California Calculator Results Explained.
Step 11. To make changes to the calculation, click ‘Edit’
Onwards!