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 coding, modifiers, guidelines, appendices and all other provisions of Current Procedural Terminology ©, Fourth Edition (“ CPT ”), published by the American Medical Association are applicable to the bills submitted for physician and non-physician practitioner services, except: (1) any provision in the Physician Fee Schedule that conflicts with a provision in CPT will take precedence over the CPT , and (2) as otherwise specified in regulation. See section 9789.19 for the version of the CPT by date of service. (b) Copies of Current Procedural Terminology ©, Fourth Edition may be purchased from the American Medical Association: ORDER DEPARTMENT AMERICAN MEDICAL ASSOCIATION P.O. BOX 930876 ATLANTA, GA 31193-0876 Or over the internet at: www.amapress.com or https://commerce.ama-assn.org/store/ Or through the American Medical Association's toll free order line: (800) 621-8335. (c) See section 9789.19 for CPT codes that shall not be used for reporting of or payment for physician services, by date of service. (d) For coding requirements for physician-administered drugs, biologicals, blood products, and vaccines, see section 9789.13.2. (e) For HCPCS codes to bill splint and cast materials, see section 9789.19, by date of service.
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).
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.