Summary
This article breaks down the process for calculating reimbursements for services rendered from July 2004 through December 31st, 2013, affected reimbursements per regulations § 9789.10 and § 9789.11 of the Physician Services Fee Schedule for workers’ compensation in California, excluding anesthesia.
After January 1st, 2014, the Physician Services fee schedule changed to the RBRVS system. For a complete outline of how to apply the Base Maximum Fee Formula for dates of service in 2014 through 2018, read our article Reimbursement for Physician Services Rendered on or after January 1, 2014 through December 31, 2018.
Table A
For services rendered before January 1st, 2014, section 9789.11 established the fee due for medical services provided by both physicians and nonphysicians. The DWC published these fees in Table A. Download Table A for the applicable dates of service on the DWC website.
Step 1. Download Table A
Step 2. Find Procedure Code OMFS Maximum
When California passed SB 863, the calculations changed. For all dates of service rendered on or after January 1st, 2014, the DWC implemented an RBRVU-based Physician Fee Schedule.
To learn how to calculate reimbursements for services rendered after January 1st, 2014, refer to the regulations or this daisyBill article. Title 8, California Code of Regulations § 9789.12.2 sets forth the formulas for services other than anesthesia. Title 8, California Code of Regulations § 9789.18.1 sets forth the formulas for anesthesia services.
California Code of Regulations (CCR)
§ 9789.11 Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014
§ 9789.111 Effective Date of Fee Schedule Provisions
Division of Workers’ Compensation Websites
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