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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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§9789.12.5. Conversion Factors.

(a) The conversion factors to be used for determining maximum reasonable fees are set forth in section 9789.19, by date of service.

(b) (1) Commencing January 1, 2014, there shall be a four-year transition between:

“OMFS Budget Neutral CF”: the estimated aggregate maximum allowable amount under the official medical fee schedule for physician services prior to January 1, 2014, and

“120% RBRVS 2012 CF”: the maximum allowable amount based on the resource-based relative value scale at 120 percent of the Medicare conversion factor in effect in July 2012.

(2) During the transition, the conversion factors before adjustment shall be as follows:

2014
2015
2016
2017
120%
(75 Percent
50 Percent
25 Percent
Type of
OMFS Budget-
2012
OMFS/25 Percent
OMFS/25 Percent
OMFS/75 Percent
120%
Service
Neutral CF
Medicare
120 % Medicare)
120 % Medicare)
120 % Medicare)
Medicare
Anesthesia
34.5903
25.6896
32.3651
30.1400
27.9148
25.6896
Surgery
55.6849
40.8451
51.9750
48.2650
44.5551
40.8451
Radiology
52.9434
40.8451
49.9188
46.8943
43.8697
40.8451
All other
34.4566
40.8451
36.0537
37.6509
39.2480
40.8451
services

(3) The conversion factors specified in subdivision (b)(2) shall be adjusted by the cumulative changes in MEI and the Relative Value Scale Adjustment Factor, if any, between 2012 and each transition year. See section 9789.19 for annual and cumulative MEI, and Relative Value Scale Adjustment Factor, by date of service.

(4)(A) During years 2014 through 2016:

(1) The anesthesia conversion factor shall be applied to CPT codes in the Anesthesia section of the CPT;

(2) The surgery conversion factor shall be applied to CPT codes in the Surgery section of the CPT;

(3) The radiology conversion factor shall be applied to CPT codes in the Radiology section of the CPT;

(4) The “other services” conversion factor shall be applied to CPT codes in the Evaluation and Management, Medicine, and Pathology and Laboratory sections of the CPT, to the extent the services are payable under this fee schedule.

(B) In 2017, and thereafter, there will be two conversion factors: Anesthesia and Other Services.

(c) For calendar year 2018, and annually thereafter, the Anesthesia conversion factor and the Other Services conversion factor in effect in the prior calendar year shall be updated by the Medicare Economic Index inflation rate and by the Relative Value Scale Adjustment Factor, if any.

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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