CA DWC Posts Draft Physician Fee Schedule For Public Comment

The forum can be found at http://www.dir.ca.gov/dwc/DWCWCABForum/dwc_PhysicianFeeSchedule.htm and members of the public may comment until July 20.

DWC's new draft regulations propose adopting the resource based relative value scale (RBRVS), as well as ground rules relating to calculation of fees. While the initial proposal was budget neutral, the revision adds funding to the physician fee schedule accrued from reductions in spinal hardware and ambulatory surgical center fees, along with system savings gained through electronic billing.

Additionally, the revised proposal makes minor grammatical changes, changes for clarity or consistency, adds detail regarding status code indicators and professional/technical code indicators, and includes the following changes to conversion factors and report fees: 

Title 8 CCR section 9789.12.4, conversion factors: 

For services other than anesthesiology, the proposal includes the use of three conversion factors—surgery, radiology, and “all other.” The proposed conversion factors are 56 for surgery codes, 57 for radiology codes, and 42 for all others. Because anesthesia services are not comparable to the relative value units (RVUs) for other services, the category has its own conversion factor. The proposed conversion factor for anesthesia services is 34.

Title 8 CCR section 9789.13.2, California specific codes and section 9789.14.1, reimbursement for reports, duplicate reports, chart notes

• Maximum reimbursement for California Code WC002, Treating Physician's Progress Report (PR-2) by primary treating physician or secondary treating physician, issued in accordance with section 9785(f), using DWC form PR-2, its narrative equivalent, or letter format where allowed, is $11.69.

Labor Code section 5307.1 grants the DWC administrative director (AD) authority to revise the official medical fee schedule (OMFS) on a periodic basis.

The initial draft of the proposed physician fee schedule was posted on DWC forum for pre-rulemaking public comment on March 22 and closed April 5.

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