For workers' comp, some physician-administered pharmaceutical reimbursements are not listed in the Medi-Cal Rates file, and can instead be found in the Medi-Cal Pharmacy Fee Schedule (also known as the DWC Pharmaceutical Fee Schedule). Remember that the Medi-Cal Rates file and the Medi-Cal Pharmacy Fee Schedule are two different fee schedules. Confusing, we know!
To access the Medi-Cal Pharmacy Fee Schedule, consult Section 9789.19 Update Table, then go to the DWC Pharmaceutical Fee Schedule and click the link. This will direct you to the DWC site's calculator, where you can use the NDC number to determine the reimbursement.
Remember that the DWC's calculator is good only for current dates of service and that it is updated every Wednesday. It does not store reimbursements for past dates of service so it may be misleading if you are entering a past date of service.
For instance, if you enter 76420052401 with a date of service of 7/1/14, the DWC's calculator will tell you that "No record matches the NDC number with a price date on or before 7/1/2014.”
However, on 7/1/2014, that NDC was a valid code—it just isn't a valid code for the current fee schedule so the DWC's calculator can't give you the correct reimbursement.
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