Where this sits
- Chapter 4.5.
- Division of Workers' Compensation
- Subchapter 1. Administrative Director - Administrative Rules
- Article 5.3. Official Medical Fee Schedule
The regulation, as printed
(a) The conversion factors to be used for determining maximum reasonable fees are set forth in section 9789.19, by date of service. (b) (1) Commencing January 1, 2014, there shall be a four-year transition between: “OMFS Budget Neutral CF”: the estimated aggregate maximum allowable amount under the official medical fee schedule for physician services prior to January 1, 2014, and “120% RBRVS 2012 CF”: the maximum allowable amount based on the resource-based relative value scale at 120 percent of the Medicare conversion factor in effect in July 2012. (2) During the transition, the conversion factors before adjustment shall be as follows: Type of Service OMFS Budget- Neutral CF 120% 2012 Medicare 2014 (75 Percent OMFS/25 Percent 120 % Medicare) 2015 (50 Percent OMFS/50 Percent 120 % Medicare) 2016 (25 Percent OMFS/75 Percent 120 % Medicare) 2017 (120% Medicare) Anesthesia 34.5903 25.6896 32.3651 30.1400 27.9148 25.6896 Surgery 55.6849 40.8451 51.9750 48.2650 44.5551 40.8451 Radiology 52.9434 40.8451 49.9188 46.8943 43.8697 40.8451 All other services 34.4566 40.8451 36.0537 37.6509 39.2480 40.8451 (3) The conversion factors specified in subdivision (b)(2) shall be adjusted by the cumulative changes in MEI and the Relative Value Scale Adjustment Factor, if any, between 2012 and each transition year. See section 9789.19 for annual and cumulative MEI, and Relative Value Scale Adjustment Factor, by date of service. (4)(A) During years 2014 through 2016: (1) The anesthesia conversion factor shall be applied to CPT codes in the Anesthesia section of the CPT; (2) The surgery conversion factor shall be applied to CPT codes in the Surgery section of the CPT; (3) The radiology conversion factor shall be applied to CPT codes in the Radiology section of the CPT; (4) The “other services” conversion factor shall be applied to CPT codes in the Evaluation and Management, Medicine, and Pathology and Laboratory sections of the CPT, to the extent the services are payable under this fee schedule. (B) In 2017, and thereafter, there will be two conversion factors: Anesthesia and Other Services. (c) For calendar year 2018, and annually thereafter, the Anesthesia conversion factor and the Other Services conversion factor in effect in the prior calendar year shall be updated by the Medicare Economic Index inflation rate and by the Relative Value Scale Adjustment Factor, if any.
The statute above this rule
Every regulation names the Labor Code it was written under. This is where the two halves of the law meet.
ImplementsLabor Code § 4600
Authority and history
Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.
1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39). 2. Editorial correction of subsection (b)(2) (Register 2015, No. 12).
No released decision named this rule
Not a comment on the rule — most of Title 8 never reaches a published panel decision, because most of it is followed without argument. The text above is the state's own.
Rules beside this one
Article 5.3. Official Medical Fee Schedule — regulations rarely stand alone, and the answer is often two sections away.
- § 9789.12.1Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services - For Services Rendered On or After January 1, 2014.
- § 9789.12.2Calculation of the Maximum Reasonable Fee - Services Other than Anesthesia.
- § 9789.12.3Status Codes C, I, N and R.
- § 9789.12.4“By Report” - Reimbursement for Unlisted Procedures/Procedures Lacking RBRVUs.
- § 9789.12.6Geographic Health Professional Shortage Area Bonus Payment: Primary Care; Mental Health.
- § 9789.12.7CMS' National Physician Fee Schedule Relative Value File / Relative Value Units (RVUs).