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Official Medical Fee Schedule (OMFS)

The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.

If you have questions regarding the Official Medical Fee Schedule (OMFS) email us at DWCFeeSchedule@dir.ca.gov.

Topics covered in the OMFS include:
Ambulance fees
Durable medical equipment, prosthetics, orthotics and supplies
Inpatient hospital
Outpatient hospital
Pathology and clinical laboratory
Pharmaceuticals
Physician services

Ambulance fees

Effective
date
Ambulance fee schedule documents
Aug. 1, 2014
  • Order of the Acting Administrative Director - Effective Aug. 1, 2014 version version
  • Regulation sections 9789.70 & 9789.110 & 9789.111 version version
  • Centers for Medicare and Medicaid Services CY 2014 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
  • For reference: CMS Manual System Transmittal No. 2788 version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 1, 2013 use:

  • Order of the acting administrative director of the Division of Workers' Compensation, Mar. 19, 2013 Word image version acrobat image version
  • Regulation sections 9789.70 & 9789.110 & 9789.111 Word image version acrobat image version
  • Centers for Medicare and Medicaid Services CY 2013 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
  • For reference: CMS Manual System Transmittal No. 2620 acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after March 1, 2012 use:

Order of the administrative director of the Division of Workers' Compensation, Feb. 8, 2012 Word image version acrobat image version

  • Centers for Medicare and Medicaid Services CY 2012 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
  • ambfspuf_2012 txt version
  • ambfspuf_2012 Excel image version
  • Ambo_PUF_CY2012_fact_sheet acrobat image version
  • PUF2012_index acrobat image version
  • For reference: CMS Manual System Transmittal No. 2310 acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation, Jan. 27, 2011 Word image version acrobat image version
  • Centers for Medicare and Medicaid Services CY 2011 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
  • ambfspuf_2011_MMEA_Rev_v2.0 txt version
  • ambfspuf_2011_MMEA_Rev_v2.0 Excel image version
  • Ambo_PUF_CY2011_fact_sheet_v2.0 acrobat image version
  • PUF2011_index acrobat image version
  • For reference: CMS Manual System Transmittal No. 2104 acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, use:

  • Regulation effective July 13, 2010 (Section 9789.70) word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2009 use:

  • Order of the administrative director of the Division of Workers' Compensation, Dec. 29, 2008 word image version acrobat image version
  • Centers for Medicare and Medicaid Services CY 2009 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
  • [SUPERSEDED - DO NOT USE: Order of the administrative director of the Division of Workers' Compensation, Dec.11, 2008 word image version acrobat image version]
  • For reference only, Centers for Medicare and Medicaid Services Sept. 18, 2008, Executive Guidance No. 0531, Change Request 6113 to Pub. 100-04 acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after July 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation, Dec. 8, 2008 word image version acrobat image version

Centers for Medicare and Medicaid Services 2008 Public Use File, as revised Oct. 1, 2008, which contains the following electronic files:

  • 2008 Ambulance Fee Schedule PUF MIPPA Update. Excel image version acrobat image version
  • 10-08_PUF 2008_MIPPA_Update index.acrobat image version
  • CY 2008 fact sheet update acrobat image version
  • The portion of the regulation of Centers for Medicare and Medicaid Services (CMS) proposed final rule entitled "Subpart H-Fee Schedule For Ambulance Services," appearing as a part of the proposed final rule of the CMS entitled, "Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; E-Prescribing Exemption for Computer-Generated Facsimile Transmissions; and Payment for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies," filed Nov. 19, 2008, and commencing at Vol. 73 FR 69725. acrobat image version

Centers for Medicare and Medicaid Services Zip Code to Carrier Locality File, as revised Nov. 13, 2008 which contains the following electronic files:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 7, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Centers for Medicare and Medicaid Services 2008 Public Use File, which contains the following electronic files:
  • 2008 Ambulance Fee Schedule PUF Excel image version acrobat image version
  • Index of Ambulance Fee Schedule public use file (Jan - Dec 2008) index acrobat image version
  • CY Ambulance Fee Schedule public use file fact sheet acrobat image version
  • 508 Compliant Version of 2008 Ambulance Fee Schedule PUF Excel image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Portions of Regulation of Centers for Medicare and Medicaid Services final rule entitled, "C. Ambulance Inflation Factor (AIF) for CY 2008", appearing as a part of the final rule of The Centers for Medicare and Medicaid Services entitled, "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; Revisions to the Payment Policies of Ambulance Services Under the Ambulance Fee Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions" (CMS-1385-FC), commencing at Vol. 72 FR 66221 and ending at 66578, filed November 27,2007. acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Feb. 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Portions of Regulation of Centers for Medicare and Medicaid Services final rule entitled, "Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; and Ambulance Inflation Factor Update for CY 2007" (CMS-1321-FC and CMS-1317-F), commencing at Vol. 71 FR 69623, filed Dec.1, 2006. acrobat image version
  • Centers for Medicare and Medicaid Services electronic files:

    The CY 2007 Public Use File acrobat image version Excel image version
    MSAvCBSA acrobat image version Excel image version
    ZIPlyout_1 acrobat image version word image version
    ZPLC0107V2 acrobat image version Excel image version
    ZPLC0107V2 acrobat image version txt version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2007 use:
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Portion of Regulation of Centers for Medicare and Medicaid Services, "D. Ambulance Inflation Factor (AIF) for 2007", appearing at page 69719 of Vol. 71, Federal Register, as a part of the rule entitled, "Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; and Ambulance Inflation Factor Update for CY 2007" (CMS-1321-FC and CMS-1317-F), commencing at Vol. 71 FR 69623, filed Dec.1, 2006. acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Centers for Medicare and Medicaid Services electronic file electronic file "Jan20052-17-05" Excel image version acrobat image version
  • Regulation of Centers for Medicare and Medicaid Services entitled "Medicare Program; Coverage and payment of ambulance services; inflation update for CY 2006" (CMS-1294-N) filed Nov.23, 2005. (Federal register Vol. 70 No. 226, Nov. 25, 2005, Vol. 70 FR 71163) acrobat image version

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Sept. 8, 2005 through Dec. 31, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Centers for Medicare and Medicaid Services electronic file electronic file "Jan20052-17-05" Excel image version acrobat image version
  • Centers for Medicare and Medicaid Services document entitled "Medicare Program; Coverage and payment of ambulance service; Recalibration of conversion factor; inflation update for CY 2005" (CMS-1267-N). (Federal register Vol. 69 No. 219, Nov. 15, 2004, Vol. 69 FR 66918) acrobat image version

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Durable medical equipment, prosthetics, orthotics and supplies

NOTE: Workers' compensation durable medical equipment, prosthetics, orthotics, and supplies fee schedule - Physician dispensed devices
Legislation that became effective on January 1, 2012 places caps on fees for "dangerous devices" dispensed by physicians. These caps are contained in Labor Code section 5307.1.

Effective
date
Fee schedule documents
Oct. 1, 2014
April 1, 2014
January 1, 2014

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2013 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2013 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after January 1, 2013 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

Workers' compensation durable medical equipment, prosthetics, orthotics, and supplies fee schedule - Physician dispensed devices
Legislation that became effective on January 1, 2012 places new caps on "dangerous devices" dispensed by physicians. These new caps are contained in Labor Code section 5307.1.

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2011, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2011, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2010, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2010, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2010, use:

  • Order of the administrative director of the Division of Workers' Compensation word image versionacrobat image version
  • [SUPERSEDED - DO NOT USE: Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2009, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2009, use:

  • Order of the administrative director of the Division of Workers' Compensation acrobat image version word image version
  • [SUPERSEDED - DO NOT USE: Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version]

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 7, 2008, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2008, use:

  • Order of the administrative director of the Division of Workers' Compensation acrobat image version word image version
  • [SUPERSEDED - DO NOT USE: Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version]

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2007, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2007, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 11, 2007, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 3, 2007, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 5, 2006, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2007, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 13, 2006, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 15, 2006, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2006, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2006, use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 15, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 15, 2005 please use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Sept. 1, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

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Inpatient hospital

For inpatient hospital discharges on or after Mar. 15, 2014 use:

  • Order of the acting administrative director of the Division of Workers' Compensation acrobat image version word image version
  • Regulation effective Mar. 15, 2013 (sections 9789.20 - 9789.25) acrobat image version word image version
  • Regulation effective Mar. 15, 2013 (section 9789.23) acrobat image version Excel image version
  • Regulation effective Mar.15, 2014 (section 9789.24) acrobat image version Excel image version

For inpatient hospital discharges on or after Mar. 15, 2013 use:

  • Order of the acting administrative director of the Division of Workers' Compensation acrobat image version word image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.20 - 9789.25) acrobat image version word image version
  • Regulation effective Mar. 15, 2013 (sections 9789.20 - 9789.25) acrobat image version word image version
  • Regulation effective Mar. 15, 2013 (section 9789.23) acrobat image version Excel image version
  • Regulation effective Mar. 15, 2013 (section 9789.24) acrobat image version Excel image version

For inpatient hospital discharges on or after Jan. 1, 2013 use:

  • Regulation effective Jan. 1, 2013 (sections 9789.20, 9789.21, 9789.22, and 9789.25) word image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.23) Excel image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.24) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.21 - 9789.24) word image version acrobat image version
  • Regulation effective Jul. 1, 2004 (section 9789.20, reprinted) word image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.21) word image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.22) word image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.23) Excel image version acrobat image version
  • Regulation effective Dec. 1, 2011 (section 9789.24) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for hospital discharges from Monrovia Memorial Hospital on or after May 1, 2009 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
    In accordance with Monrovia Memorial Hospital's request and CMS' approval, Monrovia Memorial Hospital voluntarily terminated their CMS certification number 050762 (acute care hospital) effective April 30, 2009, and became a long term acute care hospital (LTCH) CMS certification number 052054 effective as of May 1, 2009. The Order of the administrative director removes Monrovia Memorial Hospital listed as CMS provider number 050762 from Title 8, California Code of Regulations section 9789.23 for discharges on or after May 1, 2009.

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2011 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat imageversion
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.21 - 9789.24) word image version acrobat image version
  • Regulation effective Mar. 1, 2011 (section 9789.21) word image version acrobat image version
  • Regulation effective Mar. 1, 2011 (section 9789.22) word image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule to conform to August 16, 2010 final rule and correction to the final rule of October 1, 2010 changes in the Medicare payment system - hospital cost to charge ratios, hospital specific outliers, and hospital composite factors (section 9789.23) Excel image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule to conform to August 16, 2010 final rule and correction to the final rule of October 1, 2010 changes in the Medicare payment system - Medicare severity diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2009 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.20 - 9789.24) word image version acrobat image version
  • Regulation effective Dec. 1, 2009 (section 9789.21) word image version acrobat image version
  • Regulation effective Dec. 1, 2009 (section 9789.22) word image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule to conform to August 27, 2009 final rule and correction to the final rule of October 7, 2009 changes in the Medicare payment system - hospital cost to charge ratios, hospital specific outliers, and hospital composite factors (section 9789.23) Excel image version acrobat imageversion
  • Adjustment to Inpatient Hospital Fee Schedule to conform to August 27, 2009 final rule and correction to the final rule of October 7, 2009 changes in the Medicare payment system - medicare severity diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) Excel image versionacrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2008 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective Dec. 1, 2008 (Section 9789.23) Excel image version acrobat image version, is adjusted only as to listed providers, to conform to notice to the final rule published on Dec. 3, 2008 in the Federal Register (Vol. 73 FR 73656) and is entitled "Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Fiscal Year 2009 Wage Index Changes Following Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice" (CMS-1390-N2)
  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24) word image version acrobat image version
  • Regulation effective Dec. 1, 2008 (section 9789.22) word image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to the Medicare FY09 update to the inpatient prospective payment system published on Aug. 19, 2008 in the Federal Register (Vol. 73 FR 48434) and is entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals Final Rules" (CMS-1390-F; CMS-1531-IFC1; CMS-1531-IFC2; CMS-1385-F4), the correction to the final rule published on Oct. 3, 2008, in the Federal Register (Vol. 73 FR 57541), and is entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals; Correction" (CMS-1390-CN; CMS-1531-CN; CMS-1385-CN2), and the notice to the final rule published on Oct. 3, 2008 in the Federal Register (Vol. 73, FR 57888), entitled, "Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Final Fiscal Year 2009 Wage Indices and Payment Rates Including Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice" (CMS-1390-N) Excel image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to the Medicare FY09 update to the inpatient prospective payment system published on Aug.19, 2008 in the Federal Register (Vol. 73 FR 48434) and is entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals Final Rules" (CMS-1390-F; CMS-1531-IFC1; CMS-1531-IFC2; CMS-1385-F4), the correction to the final rule published on Oct. 3, 2008, in the Federal Register (Vol. 73 FR 57541), and is entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals; Correction" (CMS-1390-CN; CMS-1531-CN; CMS-1385-CN2), and the notice to the final rule published on Oct. 3, 2008 in the Federal Register (Vol. 73, FR 57888), entitled, "Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Final Fiscal Year 2009 Wage Indices and Payment Rates Including Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice" (CMS-1390-N) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Jan. 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24) word image version acrobat image version
  • Regulation effective Jan. 1, 2008 (section 9789.22) word imge version Acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to the Medicare FY08 update to the inpatient prospective payment system published on Aug. 22, 2007 in the Federal Register (Vol. 72 FR 47130) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule" (CMS-1533-FC), a correction to the final rule published on Oct. 10, 2007, in the Federal Register (Vol. 72 FR 57634) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN2), a second correction to the final rule published on November 6, 2007, in the Federal Register (Vol. 72 FR 62585) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN3), and a notice to the final rule published on Nov. 27, 2007 in the Federal Register (Vol. 72, No. 227, FR 66580) entitled "Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs; Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals" (CMS-1392-FC, CMS-1533-F2, and CMS-1531-IFC2) Excel image version Acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to the Medicare FY08 update to the inpatient prospective payment system published on Aug. 22, 2007 in the Federal Register (Vol. 72 FR 47130) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule" (CMS-1533-FC), a correction to the final rule published on Oct. 10, 2007, in the Federal Register (Vol. 72 FR 57634) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN2), a second correction to the final rule published on Nov. 6, 2007, in the Federal Register (Vol. 72 FR 62585) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN3), and a notice to the final rule published on November 27, 2007 in the Federal Register (Vol. 72, No. 227, FR 66580) entitled "Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs; Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals" (CMS-1392-FC, CMS-1533-F2, and CMS-1531-IFC2) Excel image version Acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after April 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to CMS' notice of March 23, 2007, published in the Federal Register, Vol. 72, No. 56, FR 13799, entitled, "Medicare Program; Extension of Certain Hospital Wage Index Reclassifications" (CMS-1384-N) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to CMS' correction of notice of March 23, 2007, published in Federal Register, Vol. 72, No. 56, FR 13798, entitled, "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; Corrections" (CMS-1488-CN3)
    Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2007 (section 9789.22) word image version acrobat image version
  • Regulation effective March 1, 2007 (section 9789.24 - diagnostic related groups, relative weights, geometric mean length of stay) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
    word image version acrobat image version
  • Regulation effective Dec. 1, 2006 (section 9789.22) word image version acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 18, 2006 final rule and additional notice of Oct. 11, 2006 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) Excel image version acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 18, 2006 final rule and additional notice of Oct. 11, 2006 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
    word image version acrobat image version
  • Regulation effective Dec. 1, 2005 (section 9789.22) word image version acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 12, 2005 final rule and correction notice of Sept. 30, 2005 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) Excel image version acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 12, 2005 final rule and correction notice of Sept. 30, 2005 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after July 15, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version Acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
    word image version Acrobat image version
  • Regulation effective July 15, 2005 (section 9789.22(i 2 A)) word image version Acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 11, 2004 final rule and correction notices of the Oct. 7, 2004 and Dec. 30, 2004 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) Excel image version Acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 11, 2004 final rule and correction notices of the Oct. 7, 2004 and Dec. 30, 2004 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) Excel image versionAcrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Nov. 29, 2004 use:

  • Order of the administrative director of the Division of Workers' Compensation acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, section 9789.23 word image version acrobat image version
  • Revised adjustment to Inpatient Hospital Fee Schedule to Conform to the Oct. 1, 2004 changes in the Medicare payment system - Composite Rate,

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Outpatient hospital

List of facilities electing to be paid under the high cost outlier methodology

Effective
date
Outpatient hospital Fee schedule documents
Sept. 1, 2014
  • Regulation effective September 1, 2014 (sections 9789.30 - 9789.39) version version
  • Clean copy of regulation effective September 1, 2014 version version
  • Regulation effective Apr. 1, 2013 (section 9789.34) Excel image version acrobat image version
  • Regulation effective Apr. 1, 2013 (section 9789.35) Excel image version acrobat image version

For hospital outpatient and ambulatory surgical center services rendered on or after Apr. 1, 2013 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30 through 9789.39 word image version acrobat image version
  • Regulation effective Apr. 1, 2013 (sections 9789.30 - 9789.39) word image version acrobat image version
  • Regulation effective Apr. 1, 2013 (section 9789.34) Excel image version acrobat image version
  • Regulation effective Apr. 1, 2013 (section 9789.35) Excel image version acrobat image version

For hospital outpatient departments and ambulatory surgical centers services rendered on or after Jan. 1, 2013 use:

  • Regulation effective January 1, 2013 (Sections 9789.30, 9789.31, 9789.32, 9789.33, 9789.36, 9789.37, 9789.38 and 9789.39) word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.34) Excel image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.35) Excel image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sep. 1, 2012 use:

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Mar. 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.30) word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.31) word image version acrobat image version
  • Regulation effective Mar. 1, 2009 (Section 9789.32) word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.33) word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.34) Excel image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.35) Excel image version acrobat image version
  • Regulation effective Jul. 1, 2004 (Section 9789.36) word image version acrobat image version
  • Regulation effective Jul. 1, 2004 (Section 9789.37) word image version acrobat image version
  • Regulation effective Mar. 1, 2012 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sept. 15, 2011 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.30) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.31) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.32) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.33) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation (reprinted) (Section 9789.36) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.37) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Apr. 15, 2010 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.30) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.31) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.32) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.33) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2009 use:

  • Order of the acting chief deputy administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.31) word image version acrobat image version
  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.32, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • [SUPERSEDED - DO NOT USE: Regulation effective March 1, 2009 (Section 9789.31) word image version acrobat image version ]
  • Regulation effective March 1, 2009 (Section 9789.32) word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.33) word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.31) word image version acrobat image version
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.32) word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.33) word image version acrobat image version
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.30) word image version acrobat image version
  • [SUPERSEDED - DO NOT USE: Regulation effective March 1, 2008 (Section 9789.31) word image version acrobat image version]
  • Regulation effective March 1, 2008 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after April 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Section 9789.35 - table B - Hospital specific wage index and wage adjusted conversion factor is adjusted to conform to CMS' notice of March 23, 2007, published in the Federal Register, Vol. 72, No. 56, FR 13799, entitled, "Medicare Program; Extension of Certain Hospital Wage Index Reclassifications" (CMS-1384-N) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.31) word image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Feb. 15, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31 and 9789.33 - 9789.35 word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.30) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.31) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.33) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after July 15, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31 and 9789.33 - 9789.35 word image version acrobat image version
  • Regulation effective July 15, 2005 (Section 9789.31) word image version acrobat image version
  • Regulation effective July 15, 2005 (Section 9789.33) word image version acrobat image version
  • Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - County specific wage index and wage adjusted conversion factor (section 9789.34 - table A) Excel image version acrobat image version
  • Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - Hospital specific wage index and wage adjusted conversion factor (section 9789.35 - table B) Excel image version acrobat image version

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Pathology and clinical laboratory

 

Effective
date
Fee schedule documents
April 15, 2014
Jan. 1, 2014

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2013 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Aug. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2010 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2009 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after April 15, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Sept. 1, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

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Pharmaceuticals

In addition to the regulations for services provided on or after March 1, 2007, for pharmaceuticals on or after Sept. 4, 2009 see:

  • Order of the administrative director of the Division of Workers' Compensation (does not make a change to reimbursable amounts) word image version acrobat image version

Regulation effective March 1, 2007 (Section 9789.40 ) word image version acrobat image version

Fees for pharmaceuticals

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Physician services

Labor Code section 5307.1 requires the DWC administrative director to adopt an official medical fee schedule for physician services. In California, for purposes of workers' compensation "physician" is defined by Labor Code section 3209.3 subdivision (a) as follows:

"Physician" includes physicians and surgeons holding an M.D. or D.O. degree, psychologists, acupuncturists, optometrists, dentists, podiatrists, and chiropractic practitioners licensed by California state law and within the scope of their practice as defined by California state law.

The physician fee schedule also covers services of non-physician practitioners, such as physical therapists, occupational therapists, nurse practitioners, physician assistants, clinical social workers, clinical nurse specialists, nurse anesthetists, and anesthesiologist assistants.

Rules related to paper medical treatment billing and electronic medical treatment billing are posted on the DWC website.

Effective
date
Fee schedule documents
January 1, 2014
  • Order of the Acting Administrative Director - Effective Sept. 15, 2014 version version
  • Order of the Acting Administrative Director - Effective August 15, 2014 version version
  • Order of the Acting Administrative Director - Effective July 15, 2014 version version
  • Order of the Acting Administrative Director - Effective July 1, 2014 version version
  • Order of the Acting Administrative Director - Effective July 1, 2014 version version
  • Order of the Acting Administrative Director - Effective June 15, 2014 version version
  • Order of the Acting Administrative Director - Effective May 15, 2014 version version
  • Order of the Acting Administrative Director - Effective April 15, 2014 version version
  • Order of the Acting Administrative Director - Effective April 15, 2014 version version
  • Order of the Acting Administrative Director - Effective April 1, 2014 version version
  • Order of the Acting Administrative Director - Effective March 15, 2014 version version
  • Order of the Acting Administrative Director - Effective Feb. 15, 2014 version version
  • Order of the Acting Administrative Director - Effective Jan. 23, 2014 version version
  • Order of the Acting Administrative Director - Effective Jan. 1, 2014 version version
 
  • update image Regulation effective January 1, 2014, including 9/15/2014 update (sections 9789.12.1 through 9789.19) version version
  • update image Clean copy of regulation effective January 1, 2014, including 9/15/2014 update (sections 9789.12.1 through 9789.19) version version
 

For services rendered prior to Jan. 1, 2014, the physician fee schedule includes the regulations (title 8, California Code of Regulation sections 9789.10 - 9789.11), the 1999 Official Medical Fee Schedule book, update pages for the book and a table of codes and maximum rates. See below for the relevant date of service.

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Feb. 15, 2007 use:

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after May 14, 2005 use:

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Jan. 14, 2005 use:

Order of the administrative director of the Division of Workers' Compensation rescinding two previous administrative director orders word image version acrobat image version

For services provided on or after July 1, 2004 use:

  • The 1999 edition of OMFS
  • Regulations effective July 1, 2004 (Sections 9789.10 through 9789.111) word image version acrobat image version
  • Insert Pages for the OMFS effective July 12, 2002 word image version acrobat image version)
  • General Instructions (Physician Services) effective July 1, 2004 word image version acrobat image version
  • Table A 9789.11 Excel image version acrobat image version
The links referenced in the fee schedule regulations effective July 1, 2004 are:

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For services provided between Jan. 1, 2004 and June 30, 2004 use:

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For services provided between July 12, 2002 and Dec. 31, 2003 use:
  • The 1999 edition of the OMFS
  • Regulations effective July 12, 2002 word image version acrobat image version
  • Insert pages for the OMFS effective July 12, 2002 word image version acrobat image version
  • OMFS Prosthetics Fee Schedule effective July 12, 2002 acrobat image version

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For services provided between April 1, 1999 and July 11, 2002 the 1999 edition of the OMFS should be used. Click here for the order form acrobat image

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August 2014