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) For services rendered before March 1, 2017, conscious sedation codes 99143 to 99145 may be billed as long as the procedure it is billed with is not listed in Appendix G of CPT (Summary of Codes that Include Moderate Conscious Sedation.) (b) For services rendered before March 1, 2017, when a second physician other than the health care professional performing the diagnostic or therapeutic services provides moderate sedation in the facility setting for the procedures listed in Appendix G, the second physician may bill 99148 to 99150. When these services are performed by the second physician in the nonfacility setting, CPT codes 99148 to 99150 are not to be reported. (c) If the anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. The service must meet the criteria for monitored anesthesia care. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block. However, the anesthesia service must meet the requirements for conscious sedation and if a lower level complexity anesthesia service is provided, then the conscious sedation code shall not be reported. (d) If the physician performing the medical or surgical procedure also provides a level of anesthesia lower in intensity than moderate or conscious sedation, such as a local or topical anesthesia, then the conscious sedation code shall not be reported and no payment shall be allowed. There is no CPT code for the performance of local anesthesia as payment for this service is considered to be bundled into the payment for the underlying medical or surgical service.
Official text at dir.ca.gov →
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. Amendment of subsections (a) and (b) filed 7-18-2017; operative 3-1-2017. Submitted to OAL as a file and print only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 29).
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.
- § 9789.12.5Conversion Factors.
- § 9789.12.6Geographic Health Professional Shortage Area Bonus Payment: Primary Care; Mental Health.