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Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule

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§9789.12.14. California Specific Codes.

Physicians and non-physician practitioners shall use the “California Specific Codes” listed below. Maximum reasonable fees for services performed by physicians and non-physician practitioners within their scope of practice shall be no more than the fee listed in section 9789.19, by date of service. The fees shall be updated annually in accordance with the Medicare Economic Index.

CA Code
Procedure
WC001
Doctor's First Report of Occupational Illness or Injury (Form 5021) (Section 9789.14(a)(1))
WC002
Treating Physician's Progress Report (PR-2 or narrative equivalent in accordance with ยง 9785)
(Section 9789.14(b)(1))
WC003
Primary Treating Physician's Permanent and Stationary Report (Form PR-3) (Section 9789.14(b)(2))
WC004
Primary Treating Physician's Permanent and Stationary Report (Form PR-4) (Section 9789.14(b)(3))
WC005
Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report.
Use modifier -32 (Section 9789.14(b)(4))
WC006
[Reserved]
WC007
Consultation Reports Requested by the Workers' Compensation Appeals Board or the Administrative
Director (Use modifier -32) Consultation Reports requested by the QME or AME in the context of a
medical-legal evaluation (Section 9789.14(b)(5)). (Use modifier -30)
WC008
Chart Notes (Section 9789.14(c))
WC009
Duplicate Reports (Section 9789.14(d))
WC010
Duplication of X-Ray
WC011
Duplication of Scan
WC012
Missed Appointments. This code is designated for communication only. It does not imply that compensation
is owed.

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.

HISTORY

1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39).

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