Update Table. 8 CCR § 9789.19

(a) Services Rendered On or After 1/1/2014. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document Services Rendered On or After 1/1/2014 Adjustment Factors For all services other than anesthesia: (These factors have been 2014 Total RVS adjustment factor: 1.0477 incorporated into the 2014 RVU budget neutrality factor: 1.00046 conversion factors listed 2014 RVU rescaling adjustment factor: 1.04718 below) 2014 Annual increase in the MEI: 1.008 2014 Cumulative adjustment factor: 1.0638 For anesthesia services: 2014 Total RVS adjustment factor: 1.0291 2014 RVU budget neutrality factor: 1.00046 2014 RVU rescaling adjustment factor: 1.04718 2014 anesthesia practice expense adjustment factor: 0.9823 2014 Annual increase in the MEI: 1.008 2014 Cumulative adjustment factor: 1.0449 Anesthesia Base Units 2014anesBASEfin by CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $11.91 WC003 - $38.68 for first page $23.80 each additional page. Maximum of six pages absent mutual agreement ($157.68) WC004 - $38.68 for first page $23.80 each additional page. Maximum of seven pages absent mutual agreement ($181.48) WC005 - $38.68 for first page, $23.80 each additional page. Maximum of six pages absent mutual agreement ($157.68) WC007 - $38.68 for first page $23.80 each additional page. Maximum of six pages absent mutual agreement ($157.68) WC008 - $10.26 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.26 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.13 per x-ray WC011 - $10.26 per scan WC012 - No Fee Prescribed/Non Reimbursable absent agreement CCI Edits: For services rendered on or after 1/1/2014, use: Medically Unlikely Edits “Practitioner Services MUE Table - Updated 10/1/2013.” For services rendered on or after 1/23/2014, use: “Practitioner Services MUE Table - Updated 1/1/2014.” For services rendered on or after 4/1/2014, use: “Practitioner Services MUE Table - Updated 4/1/2014.” For services rendered on or after 7/1/2014, use: “Practitioner Services MUE Table - Updated 7/1/2014.” For services rendered on or after 10/1/2014, use: “Practitioner Services MUE Table - Updated 10/1/2014.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CMS posts only the most recent version of the Practitioner Services MUE Table on the web at: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/MUE.html. CCI Edits: NCCI Policy Manual for Medicare Services - Effective January 1, 2014 [ZIP, 749KB] National Correct Coding Initiative Policy Manual Copy of the 1/1/2014 Manual is posted on the DWC website: for Medicare Services http://www.dir.ca.gov/dwc/OMFS9904.htm CCI Edits: For services rendered on or after January 1, 2014: Physician CCI Edits Physician CCI Edits v19.3 (819,852 records). The last row contains edit column 1 = 39599 and column 2 = 49570 Physician CCI Edits v19.3 (710,236 records). The first row contains edit column 1 = 40490 and column 2 = C8950 For services rendered on or after April 15, 2014: Physician CCI Edits v20.1 effective April 1, 2014 (851,137ds) records). The last row contains edit column 1 = 39599 and column 2 = 49570 Physician CCI Edits v20.1 effective April 1, 2014 (744,393 records). The first row contains edit column 1 = 40490 and column 2 = C8950 For services rendered on or after July 1, 2014: Physician CCI Edits v20.2 effective July 1, 2014 (863,712 records). The last row contains edit column 1 = 39599 and column 2 = 49570 Physician CCI Edits v20.2 effective July 1, 2014 (752,547 records). The first row contains edit column 1 = 40490 and column 2 = C8950 For services rendered on or after October 1, 2014: Physician CCI Edits v20.3 effective October 1, 2014 (864,930 records). The last row contains edit column 1 = 39599 and column 2 = 49570 Physician CCI Edits v20.3 effective October 1, 2014 (756,576 records). The first row contains edit column 1 = 40490 and column 2 = C8950 CMS' Medicare National For services rendered on or after January 1, 2014: Physician Fee Schedule RVU14A [Zip] Relative Value File [Zip] • RVUPUF14 (Excluding Attachment A) • PPRRVU14_V1219 • OPPSCAP_V1219 Excluding: 14LOCCO ANES 2014_V0103 CY 2014 GPCI _12172013 For services rendered on or after April 15, 2014: RVU14B [Zip] • RVUPUF14 (Excluding Attachment A) • PPRRVU14_V0324 • OPPSCAP_V0324 Excluding: 14LOCCO ANES_2014_V0103 CY 2014 GPCI_12172013 For services rendered on or after July 1, 2014: RVU14C [Zip 3MB] • RVUPUF14 (Excluding Attachment A) • PPRRVU14_V0515 • OPPSCAP_V0515 Excluding: 14LOCCO ANES 2014_V0103 CY 2014 GPCI_12172013 For services rendered on or after October 1, 2014: RVU14D [Zip 3MB] • RVUPUF14 (Excluding Attachment A) • PPRRVU14_V0815_v4 • OPPSCAP_V0815 Excluding: 14LOCCO ANES 2014_V0103 CY 2014 GPCI_12172013 CMS Pub 100-04 For services rendered on or after 1/1/2014, use: Medicare Claims Transmittal 2837 (Change Request 8523) Processing: Casting and Splint Supplies For services rendered on or after 4/1/2014, use: the OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of service Conversion Factors adjusted Anesthesia Conversion Factor: $33.8190 for MEI and Relative Value Surgery Conversion Factor: $55.2913 Scale adjustment factor, Radiology Conversion Factor: $53.1039 if any Other Services Conversion Factor: $38.3542 Current Procedural CPT 2014 Terminology (CPT ®) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412 and Surgery CF) CPT codes that shall not 27216 (Use G0413 and Surgery CF) be used 27217 (Use G0414 and Surgery CF) 27218 (Use G0415 and Surgery CF) 76140 (see §9789.17.2) 80100 through 80104 (see clinical lab fee schedule, § 9789.50) 90889 (See §9789.14. Use code WC005 code) 97014 (Use G0283 and Other Services CF) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456. Diagnostic Cardiovascular For services rendered on or after January 1, 2014: Procedure CPT codes RVU14A, PPRRVU14_V1219, Number “6” in Column labeled “Mult Proc” (Modifier 51) also : subject to the MPPR Addendum I, Diagnostic Cardiovascular Services Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC: http://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal- Regulation-Notices-Items/ CMS-1600-FC.html?DLPage=1&DLSort=3&DLSortDir=descending For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324, Number “6” in Column labeled “Mult Proc” (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515, Number “6” in Column labeled “Mult Proc” (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4, Number “6” in Column labeled “Mult Proc” (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC Diagnostic Imaging Family For services rendered on or after January 1, 2014: Indicator Description National Physician Fee Schedule Relative Value File Calendar Year 2014 http://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative- Value-Files-Items/RVU14A.html? DLPage=1&DLSort=0&DLSortDir=descending RVUPUF14 (PDF document) For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324, RVUPUF14 (PDF document) For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515, RVUPUF14 (PDF document) For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4, RVUPUF14 (PDF document) Diagnostic Imaging Family For services rendered on or after January 1, 2014: Indicator for Procedure RVU14A, PPRRVU14_V1219, column AB, labeled, “Diagnostic Imaging Family Indicator”. Also Addendum F, Diagnostic Imaging Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS 1600 FC For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324, column AB, labeled, “Diagnostic Imaging Family Indicator”. Also Addendum F, Diagnostic Imaging Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS 1600 FC For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515, column AB, labeled, “Diagnostic Imaging Family Indicator”. Also Addendum F, Diagnostic Imaging Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS 1600 FC For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4, column AB, labeled, “Diagnostic Imaging Family Indicator”. Also Addendum F, Diagnostic Imaging Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS 1600 FC DWC Pharmaceutical http://www.dir.ca.gov/dwc/OMFS9904.htm Fee Schedule Geographic Health 2014 Primary Care HPSA [ZIP, 97KB] Professional Shortage Area zip code data files 2014 Mental Health HPSA [ZIP, 222KB] Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov/ geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after January 1, 2014: RVU14A, PPRRVU14_V1219, with PC/TC indicator number “5” For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324, with PC/TC indicator number “5” For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515, with PC/TC indicator number “5” For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4, with PC/TC indicator number “5” Medi-Cal Rates - DHCS For services rendered on or after 1/1/2014, use: Medi-Cal Rates file - Updated 12/15/2013 For services rendered on or after 1/23/2014, use: Medi-Cal Rates file - Updated 1/15/2014 For services rendered on or after 2/15/2014, use: Medi-Cal Rates file - Updated 2/15/2014 For services rendered on or after 3/15/2014, use: Medi-Cal Rates file - Updated 3/15/2014 For services rendered on or after 6/15/2014, use: Medi-Cal Rates file - Updated 6/15/2014 For services rendered on or after 7/15/2014, use: Medi-Cal Rates file - Updated 7/15/2014 For services rendered on or after 8/15/2014, use: Medi-Cal Rates file - Updated 8/15/2014 For services rendered on or after 9/15/2014, use: Medi-Cal Rates file - Updated 9/15/2014 For services rendered on or after 10/15/2014, use: Medi-Cal Rates file - Updated 10/15/2014 For services rendered on or after 11/15/2014, use: Medi-Cal Rates file - Updated 11/15/2014 For services rendered on or after 12/15/2014, use: Medi-Cal Rates file - Updated 12/15/2014 For services rendered on or after 1/15/2015, use: Medi-Cal Rates file - Updated 1/15/2015 For services rendered on or after 2/15/2015, use: Medi-Cal Rates file - Updated 2/15/2015 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after January 1, 2014: CPT codes subject to RVU14A, PPRRVU14_V1219, Number “7” in Column labeled “Multiple Procedure (Modifier 51). Also the MPPR Addendum J, Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324, Number “7” in Column labeled “Multiple Procedure (Modifier 51). Also Addendum J, Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515, Number “7” in Column labeled “Multiple Procedure (Modifier 51). Also Addendum J, Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4, Number “7” in Column labeled “Multiple Procedure (Modifier 51). Also Addendum J, Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC Physical Therapy Multiple For services rendered on or after January 1, 2014: Procedure Payment RVU14A, PPRRVU14_V1219, Number “5” in Column labeled “Mult Proc”. Also Addendum H, Separately Reduction: “Always Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY Therapy” Codes; and 2014 CMS 1600 FC Acupuncture and Chiropractic Codes In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324 , Number “5” in Column labeled “Mult Proc”. Also Addendum H, Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515 , Number “5” in Column labeled “Mult Proc”. Also Addendum H, Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4 , Number “5” in Column labeled “Mult Proc”. Also Addendum H, Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600 FC In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 Physician Time CY 2014 PFS Physician Time [ZIP, 504KB] Radiology Diagnostic For services rendered on or after January 1, 2014: Imaging Multiple RVU14A, PPRRVU14_V1219, number “4” in column S, labeled, “Mult Proc”. Procedures For services rendered on or after April 15, 2014: RVU14B, PPRRVU14_V0324 , number “4” in column S, labeled, “Mult Proc” For services rendered on or after July 1, 2014: RVU14C, PPRRVU14_V0515 , number “4” in column S, labeled, “Mult Proc” For services rendered on or after October 1, 2014: RVU14D, PPRRVU14_V0815_v4 , number “4” in column S, labeled, “Mult Proc” Statewide GAFs Average Statewide Work GAF: 1.040 (Other than anesthesia) Average Statewide Practice Expense GAF: 1.1606 Average Statewide Malpractice Expense GAF: 0.6636 Statewide GAF (Anesthesia) Average Statewide Anesthesia GAF: 1.0313 The 1995 Documentation https://www.cms.gov/ Outreach-and-Education/Medicare-Learning- Guidelines for Evaluation & Network-MLN/ MLNEdWebGuide/Downloads/95Docguidelines.pdf Management Services The 1997 Documentation https://www.cms.gov/ Outreach-and-Education/Medicare-Learning- Guidelines for Evaluation Network-MLN/ MLNEdWebGuide/Downloads/97Docguidelines.pdf. and Management Services (b) Services Rendered On or After 3/1/2015. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document/Data Services Rendered On or After March 1, 2015 & Mid-year Updates Adjustment Factors For all services other than anesthesia: (These factors have been 2015 Cumulative Relative Value Scale adjustment factor: 1.0703 incorporated into the [2015 annual adjustment factor x 2014 cumulative adjustment factor = 2015 cumulative adjustment conversion factors listed factor (1.006 x 1.0638 = 1.0703)] below) 2015 RVS adjustment factor 2015 Annual increase in the MEI: 1.008 2015 Annual adjustment factor: 1.006 (0.9981 x 1.008) For anesthesia services: 2015 Anesthesia cumulative adjustment factor: 1.0461 [2015 anesthesia annual adjustment factor x 2014 anesthesia cumulative adjustment factor = 2015 cumulative adjustment factor (1.001 x 1.0449 = 1.0461)] 2015 Total RVS adjustment factor†: 0.9932 2015 RVU budget neutrality factor: 0.9981 2015 Anesthesia practice expense adjustment factor: 0.99506 2015 Annual increase in the MEI: 1.008 2015 Anesthesia annual adjustment factor: 1.001 [BN RVU x Anesthesia PE Adjustment x MEI = (0.9981 x 0.99506 x 1.008 ) = 1.001] †RVS adjustment factor for 2015 is 1) the RVU budget neutrality adjustment factor for “all services other than anesthesia”; and 2) the product of RVU budget neutrality adjustment factor and the anesthesia practice expense adjustment factor for anesthesia services. Anesthesia Base Units by 2014anesBASEfin CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $ 12.01 WC003 - $38.99 for first page $23.99 each additional page. Maximum of six pages absent mutual agreement ($158.94) WC004 - $38.99 for first page $23.99 each additional page. Maximum of seven pages absent mutual agreement ($182.93) WC005 - $38.99 for first page, $23.99 each additional page. Maximum of six pages absent mutual agreement ($158.94) WC007 - $38.99 for first page $23.99 each additional page. Maximum of six pages absent mutual agreement ($158.94) WC008 - $10.34 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.34 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.17 per x-ray WC011 - $10.34 per scan WC012 - No Fee Prescribed / Non Reimbursable absent agreement CCI Edits: For services rendered on or after March 1, 2015, use: Medically Unlikely Edits “Practitioner Services MUE Table - Effective 1/1/2015.” For services rendered on or after April 1, 2015, use: “Practitioner Services MUE Table - Effective 4/1/2015.” For services rendered on or after July 1, 2015, use: “Practitioner Services MUE Table - Effective 7/1/2015.” For services rendered on or after October 1, 2015, use: “Practitioner Services MUE Table - Effective 10/1/2015.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CMS posts only the most recent version of the Practitioner Services MUE Table on the web at: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/MUE.html. CCI Edits: For services rendered on or after March 1, 2015: National Correct Coding “NCCI Policy Manual for Medicare Services - Effective January 1, 2015 [ZIP, 1MB]” Initiative Policy Manual for Medicare Services Copy of the 2015 Manual is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#7 CCI Edits: For services rendered on or after March 1, 2015: Physician CCI Edits Physician CCI Edits v21.0 effective January 1, 2015 (898,800 records). The last row contains edit (Practitioner PTP Edits) column 1 = 39599 and column 2 = 49570 Physician CCI Edits v21.0 effective January 1, 2015 (787,357 records). The first row contains edit column 1 = 40490 and column 2 = C8950 For services rendered on or after April 1, 2015: Practitioner PTP Edits v21.1 effective April 1, 2015 (899,747 records ). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v21.1 effective April 1, 2015 (787,520 records ). The first row contains edits column 1 = 40490 and column 2 = C8950 For services rendered on or after July 1, 2015: Practitioner PTP Edits v21.2 effective July 1, 2015 (872,404 records ). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v21.2 effective July 1, 2015 (821,537 records ). The first row contains edits column 1 = 40490 and column 2 = 00170 For services rendered on or after October 1, 2015: Practitioner PTP Edits v21.3 effective October 1, 2015 (880,855 records). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v21.3 effective October 1, 2015 (832,093 records). The first row contains edits column 1 = 40490 and column 2 = 00170 Access the Physician CCI Edits on the CMS website: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html Note: the Physician CCI Edits excel file maintained by CMS contains effective date and deletion date (if any) for each column 1/column 2 pair. Therefore, the most recent file is the only file posted on the CMS website, and covers all time periods. CMS' Medicare National For services rendered on or after March 1, 2015: Physician Fee Schedule RVU15A (Updated 01/08/15) [ZIP, 2MB] Relative Value File [Zip] • RVUPUF15 (Excluding Attachment A) • PPRRVU15_V1223c • OPPSCAP_V1223 Excluding: 15LOCCO ANES 2015_V122314 CY2015_GPCIs For services rendered on or after May 1, 2015: RVU15B [ZIP, 3MB] • RVUPUF15 (Excluding Attachment A) • PPRRVU15_V0213_Current • OPPSCAP_V0217 Excluding: 15LOCCO Anes_2015_122314 Anes_Conv_122314_fmt CY2015_GPCIs For services rendered on or after July 1, 2015: RVU15C [ZIP, 5MB] (Except the 0.5% update is not adopted) • RVUPUF15 (Excluding Attachment A) • PPRRVU15_UP05_V0622 • OPPSCAP_UP05_V0619 Excluding: 15LOCCO Anes_2015_122314 ANES_2015_UP05_V0701 CY2015_GPCIs PPRRVU15_UP0.V0515 OPPSCAP_UP0_V0515 For services rendered on or after October 1, 2015: RVU15D [ZIP, 5MB] (Except the 0.5% update is not adopted) • RVUPUF15 (Excluding Attachment A) • PPRRVU15_OCT05_V1001 • OPPSCAP_UP05_V0815 Excluding: 15LOCCO Anes_2015_122314 ANES_2015_UP05_V0701 CY2015_GPCIs OPPSCAP_UP0_V0815 PPRRVU15_OCT_V1001 Conversion Factors adjusted Anesthesia Conversion Factor: $31.5290 for MEI and Relative Value Surgery Conversion Factor: $51.6570 Scale adjustment factor Radiology Conversion Factor: $50.1900 Other Services Conversion Factor: $40.2970 Current Procedural CPT 2015 Terminology (CPT ®) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412 and Surgery CF) CPT codes that shall 27216 (Use G0413 and Surgery CF) not be used 27217 (Use G0414 and Surgery CF) 27218 (Use G0415 and Surgery CF) 76140 (see §9789.17.2) 90889 (See §9789.14. Use code WC005 code) 97014 (Use G0283 and Other Services CF) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456. Diagnostic Cardiovascular For services rendered on or after March 1, 2015: Procedure CPT codes RVU15A, PPRRVU15_V1223c, Number “6” in Column labeled “Mult Proc” (Modifier 51), also listed subject to the MPPR in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, Number “6” in Column labeled “Mult Proc” (Modifier 51), also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, Number “6” in Column labeled “Mult Proc” (Modifier 51), also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, Number “6” in Column labeled “Mult Proc” (Modifier 51), also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple Procedure Payment Reduction (MPPR) Diagnostic Imaging Family For services rendered on or after March 1, 2015: Indicator Description Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU15A, RVUPUF15 (PDF document) For services rendered on or after May 1, 2015: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU15B, RVUPUF15 (PDF document) For services rendered on or after July 1, 2015: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU15C, RVUPUF15 (PDF document) For services rendered on or after October 1, 2015: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU15D, RVUPUF15 (PDF document) Diagnostic Imaging Family For services rendered on or after March 1, 2015: Procedures Subject to the RVU15A, PPRRVU15_V1223c, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, MPPR also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) Diagnostic Imaging For services rendered on or after March 1, 2015: Multiple Procedures RVU15A, PPRRVU15_V1223c, number “4” in column S, labeled, “Mult Proc”, also listed in CY Subject to the MPPR 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple Procedure Payment Reduction (MPPR) DWC Pharmaceutical Fee http://www.dir.ca.gov/dwc/OMFS9904.htm#8 Schedule Geographic Health 2015 Primary Care HPSA [ZIP, 88KB] Professional Shortage Area 2015 Mental Health HPSA [ZIP, 185KB] code data files Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov/ geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after March 1, 2015: RVU15A, PPRRVU15_V1223c, with PC/TC indicator number “5” For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, with PC/TC indicator number “5” For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, with PC/TC indicator number “5” For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, with PC/TC indicator number “5” Medi-Cal Rates - DHCS Pursuant to section 9789.13.2, the Medi-Cal Rates file's “Basic Rate” is used in calculating maximum fee for physician-administered drugs, biologicals, vaccines or blood products, by date of service. For services rendered on or after March 1, 2015, use: Medi-Cal Rates file - Updated 2/15/2015 For services rendered on or after March 15, 2015, use: Medi-Cal Rates file - Updated 3/15/2015 For services rendered on or after April 15, 2015, use: Medi-Cal Rates file - Updated 4/15/2015 For services rendered on or after May 15, 2015, use: Medi-Cal Rates file - Updated 5/15/2015 For services rendered on or after June 15, 2015, use: Medi-Cal Rates file - Updated 6/15/2015 For services rendered on or after July 15, 2015, use: Medi-Cal Rates file - Updated 7/15/2015 For services rendered on or after August 15, 2015, use: Medi-Cal Rates file - Updated 8/15/2015 For services rendered on or after September 15, 2015, use: Medi-Cal Rates file - Updated 9/15/2015 For services rendered on or after October 15, 2015, use: Medi-Cal Rates file - Updated 10/15/2015 For services rendered on or after November 15, 2015, use: Medi-Cal Rates file - Updated 11/15/2015 For services rendered on or after December 15, 2015, use: Medi-Cal Rates file - Updated 12/15/2015 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after March 1, 2015: CPT codes subject to the RVU15A, PPRRVU15_V1223c, Number “7” in Column labeled “Mult Proc” (Modifier 51). Also listed MPPR in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, Number “7” in Column labeled “Mult Proc” (Modifier 51). Also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, Number “7” in Column labeled “Mult Proc” (Modifier 51). Also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, Number “7” in Column labeled “Mult Proc” (Modifier 51). Also listed in CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the document CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple Procedure Payment Reduction (MPPR) Physical Therapy Multiple For services rendered on or after March 1, 2015: Procedure Payment RVU15A, PPRRVU15_V1223c, Number “5” in Column labeled “Mult Proc”. Also listed in the CY Reduction: “Always 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB] in the Therapy” Codes; and document CY_2015_PFS_1612-F Separately Payable Always Therapy Services Subject to the Multiple Acupuncture and Procedure Payment Reduction (MPPR) Chiropractic Codes In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after May 1, 2015: RVU15B, PPRRVU15_V0213_Current, Number “5” in Column labeled “Mult Proc”. Also listed in the CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after July 1, 2015: RVU15C, PPRRVU15_UP05_V0622, Number “5” in Column labeled “Mult Proc”. Also listed in the CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after October 1, 2015: RVU15D, PPRRVU15_OCT05_V1001, Number “5” in Column labeled “Mult Proc”. Also listed in the CY 2015 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR) In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 Physician Time CY 2015 PFS Final Rule Physician Time Updated 01/20/15 [ZIP 478KB] Statewide GAFs (Other Average Statewide Work GAF: 1.0420 than anesthesia) Average Statewide Practice Expense GAF: 1.1621 Average Statewide Malpractice Expense GAF: 0.7388 Statewide GAF (Anesthesia) Average Statewide Anesthesia GAF: 1.0391 Splints and Casting Supplies For services rendered on or after March 1, 2015, use: The OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of service. The 1995 Documentation https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/95Docguidelines.pdf & Management Services The 1997 Documentation https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/97Docguidelines.pdf. and Management Services (c) Services Rendered On or After 1/1/2016. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document/Data Services Rendered On or After January 1, 2016 & Mid-year Updates Adjustment Factors (These For services rendered on or after January 1, 2016: factors have been For all services other than anesthesia incorporated into the 2016 Cumulative adjustment factor: 1.0818 conversion factors listed 2016 RVU budget neutrality adjustment factor: 0.9998 below) 2016 Annual increase in the MEI: 1.011 2015 Cumulative “other than anesthesia” adjustment 1.0703 For anesthesia services: 2016 Cumulative anesthesia adjustment factor: 1.0527 2016 RVU budget neutrality adjustment factor: 0.9998 2016 Anesthesia Practice Expense and Malpractice adjustment factor: 0.99555 2016 Annual increase in the MEI: 1.011 2015 Cumulative anesthesia adjustment: 1.0461 For services rendered on or after April 1, 2016: For all services other than anesthesia: 2016 Cumulative adjustment factor: 1.0812 2016 RVU budget neutrality adjustment factor: 0.99924 2016 Annual increase in the MEI: 1.011 2015 Cumulative For anesthesia services: 2016 Cumulative anesthesia adjustment factor: 1.0317 2016 RVU budget neutrality adjustment factor: : 0.99924 2016 Anesthesia Practice Expense and Malpractice adjustment factor: 0.97628 2016 Annual increase in the MEI: 1.011 2015 Cumulative anesthesia adjustment: 1.0461 Anesthesia Base Units by 2014anesBASEfin CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $ 12.14 WC003 - $39.42 for first page $24.25 each additional page. Maximum of six pages absent mutual agreement ($160.69) WC004 - $39.42 for first page $24.25 each additional page. Maximum of seven pages absent mutual agreement ($184.94) WC005 - $39.42 for first page, $24.25 each additional page. Maximum of six pages absent mutual agreement ($160.69) WC007 - $39.42 for first page $24.25 each additional page. Maximum of six pages absent mutual agreement ($160.69) WC008 - $10.45 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.45 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.23 per x-ray WC011 - $10.45 per scan WC012 - No Fee Prescribed / Non Reimbursable absent agreement CCI Edits: For services rendered on or after January 1, 2016, use: Medically Unlikely Edits “Practitioner Services MUE Table - Effective 1/1/2016.” For services rendered on or after April 1, 2016, use: “Practitioner Services MUE Table - Effective 4/1/2016.” For services rendered on or after July 1, 2016, use: “Practitioner Services MUE Table - Effective 7/1/2016.” For services rendered on or after October 1, 2016, use: “Practitioner Services MUE Table - Effective 10/1/2016.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CMS posts only the most recent version of the Practitioner Services MUE Table on the web at: http://www.cms.gov/Medicare /Coding/NationalCorrectCodInitEd/MUE.html CCI Edits: For services rendered on or after January 1, 2016: National Correct Coding “NCCI Policy Manual for Medicare Services - Effective January 1, 2016 [ZIP, 761MB]” Initiative Policy Manual for Medicare Services Copy of the 2016 Manual is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#7 CCI Edits: Physician CCI Edits For services rendered on or after January 1, 2016: (Practitioner PTP Edits) Practitioner PTP Edits v22.0 effective January 1, 2016 (903,287 records). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v22.0 effective January 1, 2016 (866,823 records). The first row contains edits column 1 = 40490 and column 2 = 00170 For services rendered on or after April 1, 2016: Practitioner PTP Edits v22.1 effective April 1, 2016 (914,985 records). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v22.1 effective April 1, 2016 (877,109 records). The first row contains edits column 1 = 40490 and column 2 = 00170 For services rendered on or after July 1, 2016: Practitioner PTP Edits v22.2 effective July 1, 2016 (915,436 records). The last row contains edits column 1 = 39599 and column 2 = 49570 Practitioner PTP Edits v22.2 effective July 1, 2016 (877,847 records). The first row contains edits column 1 = 40490 and column 2 = 00170 For services rendered on or after October 1, 2016: Practitioner PTP Edits v22.3 effective October 1, 2016 (668,511 records) 0001M/36591 - 29999/G0354 Practitioner PTP Edits v22.3 effective October 1, 2016 (498,018 records) 30000/0213T - 49999/49570 Practitioner PTP Edits v22.3 effective October 1, 2016 (489,682 records) 50010/0213T - 79999/90784 Practitioner PTP Edits v22.3 effective October 1, 2016 (179,162 records) 80003/80002 - R0075/R0070 Access the Physician CCI Edits on the CMS website: http://www.cms.gov/Medicare /Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html Note: the Physician CCI Edits excel file maintained by CMS contains effective date and deletion date (if any) for each column 1/column 2 pair. Therefore, the most recent file is the only file posted on the CMS website, and covers all time periods. CMS' Medicare National For services rendered on or after January 1, 2016: Physician Fee Schedule RVU16A (Released January 2016) [ZIP, 3MB] Relative Value File [Zip] • RVUPUF16 (Excluding Attachment A) • PPRRVU16_V0122 • OPPSCAP_V0105 Excluding: 16LOCCO ANES_V0105 CY2016_GPCIs For services rendered on or after April 1, 2016: RVU16B (April 2016 release) [ZIP, 3MB] • RVUPUF16 (Excluding Attachment A) • PPRRVU16_April_V0202 • OPPSCAP_V0215 Excluding: 16LOCCO ANES_V0105 CY2016_GPCIs For services rendered on or after July 1, 2016: RVU16C (July 2016 release) [ZIP, 3MB] • RVUPUF16 (Excluding Attachment A) • PPRRVU16_V0517 • OPPSCAP_V0515 Excluding: 16LOCCO ANES_V0105 CY2016_GPCIs For services rendered on or after October 1, 2016: RVU16D [ZIP, 3MB] • RVUPUF16 (Excluding Attachment A) • PPRRVU16_V0804 • OPPSCAP_V0815 Excluding: 16LOCCO ANES_V0105 CY2016_GPCIs Conversion Factors adjusted For services rendered on or after January 1, 2016: for MEI and Relative Value Anesthesia Conversion Factor: $29.3852 Scale adjustment factor Surgery Conversion Factor: $48.2013 Radiology Conversion Factor: $47.4598 Other Services Conversion Factor: $42.4599 For services rendered on or after April 1, 2016: Anesthesia Conversion Factor: $28.8003 Surgery Conversion Factor: $48.1743 Radiology Conversion Factor: $47.4332 Other Services Conversion Factor: $42.4361 Current Procedural CPT 2016 Terminology (CPT®) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412 and Surgery CF) CPT codes that shall not 27216 (Use G0413 and Surgery CF) be used 27217 (Use G0414 and Surgery CF) 27218 (Use G0415 and Surgery CF) 76140 (see §9789.17.2) 90889 (See §9789.14. Use codeWC005 code) 97014 (Use G0283 and Other Services CF) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456 Diagnostic Cardiovascular For services rendered on or after January 1, 2016: Procedure CPT codes RVU16A, PPRRVU16_V0122, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed subject to the MPPR in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after April 1, 2016: RVU16B, PPRRVU16_April_V0202, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document CMS-1631-FC_ Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document CMS-1631-FC_ Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document CMS-1631-FC_ Diagnostic Cardiovascular Services Subject to MPPR Diagnostic Imaging Family For services rendered on or after January 1, 2016: Indicator Description Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU16A, RVUPUF16 (PDF document) For services rendered on or after April 1, 2016: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU16B, RVUPUF16 (PDF document) For services rendered on or after July 1, 2016: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU16C, RVUPUF16 (PDF document) For services rendered on or after October 1, 2016: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU16D, RVUPUF16 (PDF document) Diagnostic Imaging Family For services rendered on or after January 1, 2016: Procedures Subject to RVU16A, PPRRVU16_V0122, number “88” in column AB, labeled, “Diagnostic Imaging Family the MPPR Indicator”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2016: RVU16B, PPRRVU16l_V0202, number “88” in column AB, lableled, “Diagnostic Imaging Family Indicator”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [ZIP, 39 KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, number “88” in column AB, lableled, “Diagnostic Imaging Family Indicator”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [ZIP, 39 KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, number “88” in column AB, lableled, “Diagnostic Imaging Family Indicator”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [ZIP, 39 KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR Diagnostic Imaging Multiple For services rendered on or after January 1, 2016: Procedures Subject to the RVU16A, PPRRVU16_V0122, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2016 PFS MPPR Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2016: RVU16B, PPRRVU16_April_V0202, number “4” in column S, labled, “Mult Proc”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, number “4” in column S, labled, “Mult Proc”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, number “4” in column S, labled, “Mult Proc”, also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR DWC Pharmaceutical Fee http://www.dir.ca.gov/dwc/OMFS9904.htm#8 Schedule Geographic Health 2016 Primary Care HPSA [ZIP, 99KB] Professional Shortage Area 2016 Mental Health HPSA [ZIP, 239KB] zip code data files Access the files on the CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/HPSAPSAPhysicianBonuses /index.html?redirect=/hpsapsaphysicianbonuses/ Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov /geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after January 1, 2016: RVU16A, PPRRVU16_V0122, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after April 1, 2016: RVU16B, PPRRVU16_April_V0202, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) Medi-Cal Rates - DHCS Pursuant to section 9789.13.2, the Medi-Cal Rates file's “Basic Rate” is used in calculating maximum fee for physician-administered drugs, biologicals, vaccines or blood products, by date of service. For services rendered on or after January 1, 2016, use: Medi-Cal Rates file - Updated 12/15/2015 For services rendered on or after January 15, 2016, use: Medi-Cal Rates file - Updated 1/15/2016 For services rendered on or after February 15, 2016, use: Medi-Cal Rates file - Updated 2/15/2016 For services rendered on or after March 15, 2016, use: Medi-Cal Rates file - Updated 3/15/2016 For services rendered on or after April 15, 2016, use: Medi-Cal Rates file - Updated 4/15/2016 For services rendered on or after May 15, 2016, use: Medi-Cal Rates file - Updated 5/15/2016 For services rendered on or after June 15, 2016, use: Medi-Cal Rates file - Updated 6/15/2016 For services rendered on or after July 15, 2016, use: Medi-Cal Rates file - Updated 7/15/2016 For services rendered on or after August 15, 2016, use: Medi-Cal Rates file - Updated 8/15/2016 For services rendered on or after September 15, 2016, use: Medi-Cal Rates file - Updated 9/15/2016 For services rendered on or after October 15, 2016, use: Medi-Cal Rates file - Updated 10/15/2016 For services rendered on or after November 15, 2016, use: Medi-Cal Rates file - Updated 11/15/2016 For services rendered on or after December 15, 2016, use: Medi-Cal Rates file - Updated 12/15/2016 For services rendered on or after January 15, 2017, use: Medi-Cal Rates file - Updated 1/15/2017 For services rendered on or after February 15, 2017, use: Medi-Cal Rates file - Updated 2/15/2017 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after January 1, 2016: CPT codes subject to the RVU16A, PPRRVU16_V0122, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also MPPR listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after April 1, 2016: RVU16B, PPRRVU16_April_V0202, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR Physical Therapy Multiple For services rendered on or after January 1, 2016: Procedure Payment RVU16A, PPRRVU16_V0122, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2016 Reduction: “Always PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB] in the document Therapy” Codes; and CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR Acupuncture and Chiropractic Codes In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after April 1, 2016: RVU16B, PPRRVU16_April_V0202, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB] in the document CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after July 1, 2016: RVU16C, PPRRVU16_V0517, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB] in the document CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after October 1, 2016: RVU16D, PPRRVU16_V0804, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2016 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB] in the document CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 Physician Time CY 2016 PFS Final Rule Work Time [ZIP 220KB] Statewide GAFs (Other than Average Statewide Work GAF: 1.0420 anesthesia) Average Statewide Practice Expense GAF: 1.1621 Average Statewide Malpractice Expense GAF: 0.7388 Statewide GAF (Anesthesia) Average Statewide Anesthesia GAF: 1.0487 Splints and Casting Supplies For services rendered on or after January 1, 2016, use: The OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of service. The 1995 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/95Docguidelines.pdf & Management Services The 1997 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/97Docguidelines.pdf and Management Services (d) Services Rendered On or After 3/1/2017. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document/Data Services Rendered On or After March 1, 2017 & Mid-year Updates Adjustment Factors For services rendered on or after March 1, 2017: (These factors have been incorporated into the For all services other than anesthesia: conversion factors listed 2017 Cumulative adjustment factor: 1.0933 below) 2017 RVU budget neutrality adjustment factor: 0.99987 2017 Imaging MPPR adjustment factor: 0.9993 2017 Annual increase in the MEI: 1.012 2016 Cumulative “other than anesthesia” adjustment: 1.0812 For anesthesia services: 2017 Cumulative anesthesia adjustment factor: 1.0433 2017 RVU budget neutrality adjustment factor: 0.99987 2017 Imaging MPPR adjustment factor: 0.9993 2017 Annual increase in the MEI: 1.012 2016 Cumulative anesthesia adjustment: 1.0317 Anesthesia Base Units by 2014anesBASEfin CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $12.29 WC003 - $39.89 for first page $24.54 each additional page. Maximum of six pages absent mutual agreement ($162.59) WC004 - $39.89 for first page $24.54 each additional page. Maximum of seven pages absent mutual agreement ($187.13) WC005 - $39.89 for first page, $24.54 each additional page. Maximum of six pages absent mutual agreement ($162.59) WC007 - $39.89 for first page $24.54 each additional page. Maximum of six pages absent mutual agreement ($162.59) WC008 - $10.58 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.58 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.29 per x-ray WC011 - $10.58 per scan WC012 - No Fee Prescribed /Non Reimbursable absent agreement CCI Edits: For services rendered on or after March 1, 2017, use: Medically Unlikely Edits “Practitioner Services MUE Table - Effective 1/1/2017.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after April 1, 2017, use: “Practitioner Services MUE Table - Effective 4/1/2017.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after July 1, 2017, use: “Practitioner Services MUE Table - Effective 7/1/2017.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after October 1, 2017, use: “Practitioner Services MUE Table - Effective 10/1/2017.” Copies of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CMS posts only the most recent version of the Practitioner Services MUE Table on the web at: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html CCI Edits: For services rendered on or after March 1, 2017: National Correct Coding “NCCI Policy Manual for Medicare Services - Effective January 1, 2017 [ZIP, 770KB]” Initiative Policy Manual for Medicare Services Copy of the 2017 Manual is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#7 CCI Edits: For services rendered on or after March 1, 2017: Physician CCI Edits Practitioner PTP Edits v23.0 effective January 1, 2017 (422,052 records) 0001M/36591 - 24940/G0471 (Practitioner PTP Edits) Practitioner PTP Edits v23.0 effective January 1, 2017 (574,135 records) 25000/01810 - 39599/49570 Practitioner PTP Edits v23.0 effective January 1, 2017 (436,857 records) 40490/00170 - 59897/G0347 Practitioner PTP Edits v23.0 effective January 1, 2017 (501,820 records) 60000/0213T - R0075/R0070 For services rendered on or after April 1, 2017: Practitioner PTP Edits v23.1 effective April 1, 2017 (474,500 records) 0001M/36591 - 25931/G0471 Practitioner PTP Edits v23.1 effective April 1, 2017 (502,046 records) 26010/01810 - 36909/J2001 Practitioner PTP Edits v23.1 effective April 1, 2017 (495,097 records) 37140/0213T - 60650/G0471 Practitioner PTP Edits v23.1 effective April 1, 2017 (501,223 records) 61000/0213T - R0075/R0070 For services rendered on or after July 1, 2017: Practitioner PTP Edits v23.2 effective July 1, 2017 (476,159 records) 0001M/36591 - 25931/G0471 [ZIP, 13MB] Practitioner PTP Edits v23.2 effective July 1, 2017 (502,166 records) 26010/01810 - 36909/J2001 [ZIP, 13MB] Practitioner PTP Edits v23.2 effective July 1, 2017 (495,291 records) 37140/0213T - 60650/G0471 [ZIP, 13MB] Practitioner PTP Edits v23.2 effective July 1, 2017 (503,693 records) 61000/0213T - R0075/R0070 [ZIP, 13MB] For services rendered on or after October 1, 2017: Practitioner PTP Edits v23.3 effective October 1, 2017 (476,064 records) 0001M/36591 - 25931/G0471 Practitioner PTP Edits v23.3 effective October 1, 2017 (502,759 records) 26010/01810 - 36909/J2001 Practitioner PTP Edits v23.3 effective October 1, 2017 (495,446 records) 37140/0213T - 60650/G0471 Practitioner PTP Edits v23.3 effective October 1, 2017 (504,589 records) 61000/0213T - R0075/R0070 Access the Physician CCI Edits on the CMS website: http://www.cms.gov/Medicare /Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html Note: the Physician CCI Edits excel file maintained by CMS contains effective date and deletion date (if any) for each column 1/column 2 pair. Therefore, the most recent file is the only file posted on the CMS website, and covers all time periods. CMS' Medicare National For services rendered on or after March 1, 2017: Physician Fee Schedule RVU17A (January 2017 release) [ZIP, 3MB] Relative Value File [Zip] • RVU17A (Excluding Attachment A) • PPRRVU17_V1219 • OPPSCAP_V1219 Excluding: 17LOCCO ANES_V0101 CY2017_GPCIs For services rendered on or after April 1, 2017: RVU17B [ZIP, 3MB] • RVU17B (Excluding Attachment A) • PPRRVU17_V0209 • OPPSCAP_V0215 Excluding: 17LOCCO ANES_V0101 CY2017_GPCIs For services rendered on or after July 1, 2017: RVU17C [ZIP, 3MB] • RVU17C (Excluding Attachment A) • PPRRVU17_JULY_V0503 • OPPSCAP_V0515 Excluding: 17LOCCO ANES_V0101 CY2017_GPCIs For services rendered on or after October 1, 2017: RVU17D [ZIP, 3MB] • RVU17D (Excluding Attachment A) • PPRRVU17_OCT • OPPSCAP_OCT Excluding: 17LOCCO ANES_OCT CY2017_GPCIs Conversion Factors adjusted For services rendered on or after March 1, 2017: for MEI and Relative Value Scale adjustment Anesthesia Conversion Factor: $26.8011 factor Other Services Conversion Factor: $ 44.6572 Current Procedural CPT 2017 Terminology (CPT(r)) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412) CPT codes that shall not 27216 (Use G0413) be used 27217 (Use G0414) 27218 (Use G0415) 76140 (see §9789.17.2) 90889 (See §9789.14. Use code WC005) 97014 (Use G0283) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456 Diagnostic Cardiovascular For services rendered on or after March 1, 2017: Procedure CPT codes RVU17A, PPRRVU17_V1219, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in subject to the MPPR CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, Number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR Diagnostic Imaging Family For services rendered on or after March 1, 2017: Indicator Description Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU17A, RVU17A (PDF document) For services rendered on or after April 1, 2017: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU17B, RVU17B (PDF document) For services rendered on or after July 1, 2017: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU17C, RVU17C (PDF document) For services rendered on or after October 1, 2017: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU17D, RVUPUF17 (PDF document) Diagnostic Imaging Family For services rendered on or after March 1, 2017: Procedures Subject to the RVU17A, PPRRVU17_V1219, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, MPPR also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F _Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F _Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator”, also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F _Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator,” also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F _Diagnostic Imaging Services Subject to MPPR Diagnostic Imaging For services rendered on or after March 1, 2017: Multiple Procedures RVU17A, PPRRVU17_V1219, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2017 PFS Subject to the MPPR Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, number “4” in column S, labeled, “Mult Proc”, also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, number “4” in column S, labeled, “Mult Proc,” also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR DWC Pharmaceutical http://www.dir.ca.gov/dwc/OMFS9904.htm#8 Fee Schedule Geographic Health 2017 Primary Care HPSA [ZIP, 99KB] Professional Shortage Area 2017 Mental Health HPSA [ZIP, 237KB] zip code data files Access the files on the CMS website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ HPSAPSAPhysicianBonuses/ index.html?redirect=/hpsapsaphysicianbonuses/ Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov/ geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after March 1, 2017: RVU17A, PPRRVU17_V1219, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, number “5” in column N, labeled, “PCTC IND”, (PC/TC Indicator) For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) Medi-Cal Rates - DHCS Pursuant to section 9789.13.2, the Medi-Cal Rates file's “Basic Rate” is used in calculating maximum fee for physician-administered drugs, biologicals, vaccines or blood products, by date of service. For services rendered on or after March 1, 2017 use: Medi-Cal Rates file - Updated 2/15/2017 For services rendered on or after March 15, 2017, use: Medi-Cal Rates file - Updated 3/15/2017 For services rendered on or after April 15, 2017, use: Medi-Cal Rates file - Updated 4/15/2017 For services rendered on or after May 15, 2017, use: Medi-Cal Rates file - Updated 5/15/2017 For services rendered on or after June 15, 2017, use: Medi-Cal Rates file - Updated 6/15/2017 For services rendered on or after July 15, 2017, use: Medi-Cal Rates file - Updated 7/15/2017 For services rendered on or after August 15, 2017, use: Medi-Cal Rates file - Updated 8/15/2017 For services rendered on or after September 15, 2017, use: Medi-Cal Rates file - Updated 9/15/2017 For services rendered on or after October 15, 2017, use: Medi-Cal Rates file - Updated 10/15/2017 For services rendered on or after November 15, 2017, use: Medi-Cal Rates file - Updated 11/15/2017 For services rendered on or after December 15, 2017, use: Medi-Cal Rates file - Updated 12/15/2017 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after March 1, 2017: CPT codes subject to the RVU17A, PPRRVU17_V1219, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in MPPR CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, Number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR Physical Therapy Multiple For services rendered on or after March 1, 2017: Procedure Payment RVU17A, PPRRVU17_V1219, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2017 Reduction: “Always PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB] in the document Therapy” Codes; and CMS-1654-F_Separately Payable Therapy Services Subject to MPPR Acupuncture and Chiropractic Codes In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after April 1, 2017: RVU17B, PPRRVU17_V0209, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB] in the document CMS-1654-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after July 1, 2017: RVU17C, PPRRVU17_JULY_V0503, Number “5” in column S, labeled “Mult Proc”. Also listed in the CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB] in the document CMS-1654-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after October 1, 2017: RVU17D, PPRRVU17_OCT, Number “5” in column S, labeled “Mult Proc.” Also listed in the CY 2017 PFS Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB] in the document CMS-1654-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 Physician Time CY 2017 PFS Final Rule Physician Time [ZIP, 628KB] Statewide GAFs (Other Average Statewide Work GAF: 1.0417 than anesthesia) Average Statewide Practice Expense GAF: 1.1632 Average Statewide Malpractice Expense GAF: 0.6632 Statewide GAF Average Statewide Anesthesia GAF: 1.0374 (Anesthesia) Splints and Casting For services rendered on or after March 1, 2017, use: Supplies The OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of service. The 1995 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/95Docguidelines.pdf & Management Services The 1997 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/97Docguidelines.pdf and Management Services (e) Services Rendered On or After 1/1/2018. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document/Data Services Rendered On or After January 1, 2018 & Mid-year Updates Adjustment Factors For services rendered on or after January 1, 2018: (These factors have been incorporated into the For all services other than anesthesia: conversion factors 2018 Cumulative adjustment factor: 1.1075 listed below) 2018 RVU budget neutrality adjustment factor: 0.9990 2018 Annual increase in the MEI: 1.014 2017 Cumulative “other than anesthesia” adjustment: 1.0933 For anesthesia services: 2018 Cumulative anesthesia adjustment factor: 1.0604 2018 RVU budget neutrality adjustment factor: 0.9990 2018 Annual increase in the MEI: 1.014 2018 Anesthesia practice expense and malpractice adjustment factor: 1.0034 2017 Cumulative anesthesia adjustment: 1.0433 Anesthesia Base Units by cms1676f_cy_2018_anesthesia_base_units.xlsx CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $12.46 WC003 - $40.45 for first page $24.88 each additional page. Maximum of six pages absent mutual agreement ($164.85) WC004 - $40.45 for first page $24.88 each additional page. Maximum of seven pages absent mutual agreement ($189.73) WC005 - $40.45 for first page, $24.88 each additional page. Maximum of six pages absent mutual agreement ($164.85) WC007 - $40.45 for first page $24.88 each additional page. Maximum of six pages absent mutual agreement ($164.85) WC008 - $10.73 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.73 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.36 per x-ray WC011 - $10.73 per scan WC012 - No Fee Prescribed/Non Reimbursable absent agreement CCI Edits: For services rendered on or after January 1, 2018, use: Medically Unlikely Edits “Practitioner Services MUE Table - Effective 1/1/18.” Copy of the MUE Table is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after April 1, 2018, use: “Practitioner Services MUE Table - Effective 4/1/18.” Copy of the MUE Table is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after July 1, 2018, use: “Practitioner Services MUE Table - Effective 07-01-2018 [ZIP, 346KB],” excluding all codes listed with Practitioner Services MUE Value of “0” (zero). Excerpts of the MUE Table is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm For services rendered on or after October 1, 2018, use: “Practitioner Services MUE Table - Effective 10-01-2018 [ZIP, 346KB],” excluding all codes listed with Practitioner Services MUE Value of “0” (zero). Excerpts of the MUE Table is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CCI Edits: For services rendered on or after January 1, 2018: National Correct Coding “NCCI Policy Manual for Medicare Services - Effective January 1, 2018 [ZIP, 851KB]” Initiative Policy Manual for Medicare Services Copy of the 2018 Manual is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#7 CCI Edits: For services rendered on or after January 1, 2018: Practitioner Procedure to Procedure (PTP) Edits Practitioner PTP Edits v24.0 effective January 1, 2018 (511,599 records) 0001M/36591 - 25931/G0471 Practitioner PTP Edits v24.0 effective January 1, 2018 (507,927 records) 26010/01810 - 36909/J2001 Practitioner PTP Edits v24.0 effective January 1, 2018 (474,903 records) 37140/0213T - 60650/G0471 Practitioner PTP Edits v24.0 effective January 1, 2018 (514,837 records) 61000/0213T - R0075/R0070 For services rendered on or after April 1, 2018: Practitioner PTP Edits v24.1 effective April 1, 2018 (537,183 records) 0001M/36591 - 25931/G0471 Practitioner PTP Edits v24.1 effective April 1, 2018 (482,358 records) 26010/01810 - 36909/J2001 Practitioner PTP Edits v24.1 effective April 1, 2018 (523,111 records) 37140/0213T - 60650/G0471 Services Rendered On or After January 1, 2018 & Mid-year Updates Practitioner PTP Edits v24.1 effective April 1, 2018 (466,820 records) 61000/0213T - R0075/R0070 For services rendered on or after July 1, 2018: Practitioner PTP Edits v24.2 effective July 1, 2018 (539,120 records) 0001M/36591 - 26992/G0471 Practitioner PTP Edits v24.2 effective July 1, 2018 (482,378 records) 27000/01995 - 37790/G0471 Practitioner PTP Edits v24.2 effective July 1, 2018 (523,129 records) 38100/0213T - 61888/G0471 Practitioner PTP Edits v24.2 effective July 1, 2018 (467,725 records) 62000/0213T - R0075/R0070 For services rendered on or after October 1, 2018: Practitioner PTP Edits v24.3 effective October 1, 2018 (539,717 records) 0001M/36591 - 26992/G0471 Practitioner PTP Edits v24.3 effective October 1, 2018 (482,493 records) 27000/01995 - 37790/G0471 Practitioner PTP Edits v24.3 effective October 1, 2018 (523,504 records) 38100/0213T - 61888/G0471 Practitioner PTP Edits v24.3 effective October 1, 2018 (467,777 records) 62000/0213T - R0075/R0070 Access the Practitioner PTP Edits on the CMS website: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html Note: the Practitioner PTP Edits excel file maintained by CMS contains effective date and deletion date (if any) for each column 1/column 2 pair. Therefore, the most recent file is the only file posted on the CMS website, and covers all time periods. CMS' Medicare National For services rendered on or after January 1, 2018: Physician Fee Schedule RVU18A (Updated 12/20/2017) [ZIP, 3MB] Relative Value File [Zip] • RVU18A (excluding Attachment A) • PPRRVU18 JAN • OPPSCAP_JAN Excluding: 18LOCCO ANES2018 GPCI2018 For services rendered on or after April 1, 2018: RVU18B [ZIP, 3MB] • RVU18B (excluding Attachment A) • PPRRVU18 APR • OPPSCAP_APR Excluding: 18LOCCO ANES2018 GPCI2018 For services rendered on or after July 1, 2018: RVU18C1 [ZIP, 3MB] • RVU18C (excluding Attachment A) • PPRRVU18 JUL • OPPSCAP_JUL Excluding: 18LOCCO ANES2018 GPCI2018 For services rendered on or after October 1, 2018: RVU18D [ZIP, 3MB] • RVU18D (excluding Attachment A) • PPRRVU18 OCT • OPPSCAP_OCT Excluding: 18LOCCO ANES2018 GPCI2018 Conversion Factors adjusted For services rendered on or after January 1, 2018: for MEI and Relative Value Scale adjustment factor Anesthesia Conversion Factor: $27.2415 Other Services Conversion Factor: $45.2371 Current Procedural CPT 2018 Terminology (CPT®) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412) CPT codes that shall not 27216 (Use G0413) be used 27217 (Use G0414) 27218 (Use G0415) 76140 (see §9789.17.2) 90889 (See §9789.14. Use codeWC005 code) 97014 (Use G0283) 97127 (Use G0515) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456 Diagnostic Cardiovascular For services rendered on or after January 1, 2018: Procedure CPT codes RVU18A, PPRRVU18_JAN, number “6” in column S, subject to the MPPR labeled “Mult Proc” (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “6” in column S, labeled “Mult Proc” (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR Diagnostic Imaging Family For services rendered on or after January 1, 2018: Indicator Description Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU18A, RVU18A (PDF document) For services rendered on or after April 1, 2018: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU18B, RVU18B (PDF document) For services rendered on or after July 1, 2018: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU18C1, RVU18C (PDF document) For services rendered on or after October 1, 2018: Diagnostic Imaging Family Indicator: 88 = Subject to the reduction 99 = Concept does not apply RVU18D, RVU18D (PDF document) Diagnostic Imaging Family For services rendered on or after January 1, 2018: Procedures Subject to the RVU18A, PPRRVU18_JAN, number “88” in column AB, MPPR labeled, “Diagnostic Imaging Family Indicator,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR Diagnostic Imaging For services rendered on or after January 1, 2018: Multiple Procedures RVU18A, PPRRVU18_JAN, number “4” in column S, labeled, “Mult Proc,” also listed in Subject to the MPPR CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “4” in column S, labeled, “Mult Proc,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “4” in column S, labeled, “Mult Proc,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “4” in column S, labeled, “Mult Proc,” also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR DWC Pharmaceutical http://www.dir.ca.gov/dwc/OMFS9904.htm#8 Fee Schedule Geographic Health 2018 Primary Care HPSA [ZIP, 98KB] Professional 2018 Mental Health HPSA [ZIP, 218KB] Shortage Area zip code Access the files on the CMS website: data files https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HPSAPSAPhysicianBonuses/ index.html?redirect=/hpsapsaphysicianbonuses/ Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov/ geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after January 1, 2018: RVU18A, PPRRVU18_JAN, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) Medi-Cal Rates - DHCS fee for physician-administered drugs, biologicals, vaccines or blood products, by date of service. For services rendered on or after January 1, 2018, use: Medi-Cal Rates file - Updated 12/15/2017 For services rendered on or after January 15, 2018, use: Medi-Cal Rates file - Updated 1/15/2018 For services rendered on or after February 15, 2018, use: Medi-Cal Rates file - Updated 2/15/2018 For services rendered on or after March 15, 2018, use: Medi-Cal Rates file - Updated 3/15/2018 For services rendered on or after April 15, 2018, use: Medi-Cal Rates file - Updated 4/15/2018 For services rendered on or after May 15, 2018, use: Medi-Cal Rates file - Updated 5/15/2018 For services rendered on or after June 15, 2018, use: Medi-Cal Rates file - Updated 6/15/2018 For services rendered on or after July 15, 2018, use: Medi-Cal Rates file - Updated 7/15/2018 For services rendered on or after August 15, 2018, use: Medi-Cal Rates file - Updated 8/15/2018 For services rendered on or after September 15, 2018, use: Medi-Cal Rates file - Updated 9/15/2018 For services rendered on or after October 15, 2018, use: Medi-Cal Rates file - Updated 10/15/2018 For services rendered on or after November 15, 2018, use: Medi-Cal Rates file - Updated 11/15/2018 For services rendered on or after December 15, 2018, use: Medi-Cal Rates file - Updated 12/15/2018 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after January 1, 2018: CPT codes subject to RVU18A, PPRRVU18_JAN, number “7” in column S, labeled “Mult Proc” (Modifier 51). the MPPR Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “7” in column S, labeled “Mult Proc” (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR Physical Therapy Multiple For services rendered on or after January 1, 2018: Procedure Payment RVU18A, PPRRVU18_JAN, number “5” in column S, labeled “Mult Proc.” Reduction: “Always Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], Therapy” Codes; and in the document CMS-1676-F_Separately Payable Therapy Services Subject to MPPR Acupuncture and Chiropractic Codes In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after April 1, 2018: RVU18B, PPRRVU18_APR, number “5” in column S, labeled “Mult Proc.” Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after July 1, 2018: RVU18C1, PPRRVU18_JUL, number “5” in column S, labeled “Mult Proc.” Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 For services rendered on or after October 1, 2018: RVU18D, PPRRVU18_OCT, number “5” in column S, labeled “Mult Proc.” Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable Therapy Services Subject to MPPR In addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942, 98943 Physician Time CY 2018 PFS Final Rule Physician Time [ZIP, 591KB] Statewide GAFs (Other Average Statewide Work GAF: 1.041 than anesthesia) Average Statewide Practice Expense GAF: 1.166 Average Statewide Malpractice Expense GAF: 0.605 Statewide GAF (Anesthesia) Average Statewide Anesthesia GAF: 1.034 Splints and Casting Supplies For services rendered on or after January 1, 2018, use: The OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of service. The 1995 Documentation https://www.cms.gov/ Outreach-and-Education/Medicare-Learning-Network-MLN/ Guidelines for Evaluation MLNEdWebGuide/Downloads/ 95Docguidelines.pdf & Management Services The 1997 Documentation https://www.cms.gov/ Outreach-and-Education/Medicare-Learning-Network-MLN/ Guidelines for Evaluation MLNEdWebGuide/Downloads/ 97Docguidelines.pdf & Management Services (f) Services Rendered On or After January 1, 2019. Documents listed in the following table are incorporated by reference and will be made available upon request to the Administrative Director. Document/Data Services Rendered On or After January 1, 2019 & Mid-year Updates Adjustment Factors For all services other than anesthesia: (These factors have been 2019 Cumulative adjustment factor: 1.1226 incorporated into the 2019 RVU budget neutrality adjustment factor: 0.9986 conversion factors listed 2019 Annual increase in the MEI: 1.015 below) 2018 Cumulative “other than anesthesia” adjustment: 1.1075 For anesthesia services: 2019 Cumulative anesthesia adjustment factor: 1.0777 2019 RVU budget neutrality adjustment factor: 0.9986 2019 Annual increase in the MEI: 1.015 2019 Anesthesia practice expense and malpractice adjustment factor: 1.0027 2018 Cumulative anesthesia adjustment: 1.0604 Anesthesia Base Units by cms1676f_cy_2018_anesthesia_base_units.xlsx CPT Code California-Specific Codes WC001 - Not reimbursable WC002 - $12.65 WC003 - $41.06 for first page $25.25 each additional page. Maximum of six pages absent mutual agreement ($167.31) WC004 - $41.06 for first page $25.25 each additional page. Maximum of seven pages absent mutual agreement ($192.56) WC005 - $41.06 for first page, $25.25 each additional page. Maximum of six pages absent mutual agreement ($167.31) WC007 - $41.06 for first page $25.25 each additional page. Maximum of six pages absent mutual agreement ($167.31) WC008 - $10.89 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC009 - $10.89 for up to the first 15 pages. $0.25 for each additional page after the first 15 pages. WC010 - $5.44 per x-ray WC011 - $10.89 per scan WC012 - No Fee Prescribed/Non Reimbursable absent agreement CCI Edits: Medically Unlikely Edits For services rendered on or after January 1, 2019, use: “Practitioner Services MUE Table - Effective 01/01/2019,” [ZIP, 350KB]” excluding all codes listed with Practitioner Services MUE Value of “0” (zero). Excerpts of the MUE Tables are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm CCI Edits: “NCCI Policy Manual for Medicare Services - Effective January 1, 2019 [ZIP, 1MB]” National Correct Coding Initiative Policy Manual Copy of the 2019 Manual is posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm#7 for Medicare Services CCI Edits: For services rendered on or after January 1, 2019: Practitioner Procedure to Procedure (PTP) Edits Practitioner PTP Edits v25.0 effective January 1, 2019 (556,965 records) 0001M/36591-26992/G0471 Practitioner PTP Edits v25.0 effective January 1, 2019 (489,643 records) 27000/01995-37790/G0471 Practitioner PTP Edits V25.0 effective January 1, 2019 (529,244 records) 38100/0213T-61888/G0471 Practitioner PTP Edits v25.0 effective January 1, 2019 (483,364 records) 62000/0213T-R0075/R0070 Access the Practitioner PTP Edits on the CMS website: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html Note: the Practitioner PTP Edits excel file maintained by CMS contains effective date and deletion date (if any) for each column 1/column 2 pair. Therefore, the most recent file is the only file posted on the CMS website, and covers all time periods. CMS' Medicare National For services rendered on or after January 1, 2019: Physician Fee Schedule RVU19A [ZIP, XMB] Relative Value File [Zip] • RVU19A-508 (Excluding Attachment A) • PPRRVU19 Jan • OPPSCAP_Jan • 19LOCCO • GPCI2019 Excluding: ANES2019 Access the Relative Value File on the CMS website: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative- Value-Files.html Conversion Factors Anesthesia Conversion Factor: $27.6859 adjusted for MEI and Relative Value Scale Other Services Conversion Factor: $45.8513 adjustment factor Current Procedural CPT 2019 Terminology (CPT®) https://commerce.ama-assn.org/store/ Current Procedural Do not use CPT codes: Terminology 27215 (Use G0412) CPT codes that shall 27216 (Use G0413) not be used 27217 (Use G0414) 27218 (Use G0415) 76140 (see §9789.17.2) 90889 (See §9789.14. Use codeWC005 code) 97014 (Use G0283) 97127 (Use G0515) 99075 (see Medical-Legal fee schedule, §9795) 99080 (see §9789.14) 99241 through 99245 (see §9789.12.12) 99251 through 99255 (see §9789.12.12) 99455 and 99456 Diagnostic Cardiovascular For services rendered on or after January 1, 2019: Procedure CPT codes RVU19A, PPRRVU19_Jan, number “6” in column S, labeled “Mult Proc” (Modifier 51), subject to the MPPR also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Cardiovascular Services Subject to MPPR Diagnostic Imaging For services rendered on or after January 1, 2019: Family Indicator Diagnostic Imaging Family Indicator: Description 88 = Subject to the reduction 99 = Concept does not apply RVU19A, RVU19A-508 (PDF document) Diagnostic Imaging For services rendered on or after January 1, 2019: Family Procedures RVU19A, PPRRVU19_Jan, number “88” in column AB, labeled, “Diagnostic Imaging Family Indicator,” Subject to the MPPR also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to MPPR Diagnostic Imaging For services rendered on or after January 1, 2019: Multiple Procedures RVU19A, PPRRVU19_Jan, number “4” in column S, labeled, “Mult Proc,” Subject to the MPPR also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to MPPR DWC Pharmaceutical http://www.dir.ca.gov/dwc/OMFS9904.htm#8 Fee Schedule Geographic Practice Cost For services rendered on or after January 1, 2019: Index (GPCI) by locality RVU19A (Other than anesthesia • GPCI9019 Addendum E - Column B (“Locality Number”), Column C (“Locality Name”), services) column D (“2019 PW GPCI”), column E (“PE GPCI”), and column F (“MP GPCI”) for the State of California (“CA”) • 19LOCCO - Column B (“Locality Number”), column C (“State”), column D (“Fee Schedule Area”) and column E (“Counties”) for the State of California (“CA”) Access the Relative Value File on the CMS website: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative- Value-Files.html Also, see Zip Code mapping files listed below. Geographic Practice Cost For services rendered on or after January 1, 2019: Index (GPCIs) by locality and anesthesia shares 2019 Anesthesia Conversion Factors [ZIP, 18KB] (These factors have been incorporated into the conversion (Anesthesia) factors listed on section 9789.19.1, Table A) • Locality-Adjusted Anesthesia Conversion Factors as a result of the CY 2019 Final Rule, excluding column G labeled, “National Anes CF of 22.2730” • Anesthesia Shares RVU19A (County to locality index) • 19LOCCO - Column B (“Locality Number”), column C (“State”), column D (“Fee Schedule Area”) and column E (“Counties”) for the State of California (“CA”) Access the Anesthesia Conversion Factors File on the CMS website: https://www.cms.gov/Center/ Provider-Type/Anesthesiologists-Center.html Access the Relative Value File on the CMS website: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative- Value-Files.html Also, see Zip Code mapping files listed below. Geographic Practice Cost For services rendered on or after January 1, 2019: Index (GPCI) locality mapping Zip Code to Carrier Locality File - Revised 11/14/2018 [ZIP, 4MB], Column A (“STATE”), column B (“ZIP CODE”), and column D (“LOCALITY”) for the State of California (“CA”) Zip Code files mapping Zip Codes requiring + 4 extension - Revised 11/14/2018 [ZIP, 1KB], for the State of California (“CA”) zip codes to GPCI locality (for “other than The Zip Code files can be accessed on the CMS website: anesthesia services” and https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html anesthesia services) Geographic Health 2019 Primary Care HPSA [ZIP, 100KB] Professional Shortage 2019 Mental Health HPSA [ZIP, 218KB] Area zip code data files Access the files on the CMS website: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/ index.html?redirect=/hpsapsaphysicianbonuses/ Health Resources and Services Administration: Geographic HPSA shortage area query (By State & County) http://hpsafind.hrsa.gov/ (By Address) http://datawarehouse.hrsa.gov/ geoHPSAAdvisor/GeographicHPSAAdvisor.aspx Incident To Codes For services rendered on or after January 1, 2019: RVU19A, PPRRVU19_Jan, number “5” in column N, labeled, “PCTC IND,” (PC/TC Indicator) Medi-Cal Rates - DHCS Pursuant to section 9789.13.2, the Medi-Cal Rates file's “Basic Rate” is used in calculating maximum fee for physician-administered drugs, biologicals, vaccines or blood products, by date of service. For services rendered on or after January 1, 2019, use: Medi-Cal Rates file - Updated 12/15/2018 Copies of the Medi-Cal Rates files (without CPT descriptors) are posted on the DWC website: http://www.dir.ca.gov/dwc/OMFS9904.htm Ophthalmology Procedure For services rendered on or after January 1, 2019: CPT codes subject to RVU19A, PPRRVU19_Jan, number “7” in column S, labeled “Mult Proc” (Modifier 51). the MPPR Also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Ophthalmology Services Subject to MPPR Physical Therapy Multiple For services rendered on or after January 1, 2019: Procedure Payment RVU19A, PPRRVU19_Jan, number “5” in column S, labeled “Mult Proc.” Reduction: “Always Also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], Therapy” Codes; and in the document CMS-1693-F_Separately Payable Therapy Services Subject to MPPR Chiropractic Codes In addition, CPT codes: 98940, 98941, 98942, 98943 Physician Time CY 2019 PFS Final Rule Physician Time [ZIP, 244KB] Splints and Casting The OMFS Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) Fee Schedule applicable Supplies to the date of service. The 1995 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/95Docguidelines.pdf & Management Services The 1997 Documentation https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/ Guidelines for Evaluation Downloads/97Docguidelines.pdf & Management Services