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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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§9789.15.1. Non-Physician Practitioner (NPP) - Payment Methodology.

(a) For purposes of this section, NPP services means services provided by physician assistants, nurse practitioners, clinical nurse specialists, and clinical social workers.

(b) Except for clinical social workers, maximum fees for NPP services shall be 85 percent of what a physician is paid under the Official Medical Fee Schedule - Physician Fee Schedule. Maximum fees for clinical social workers shall be 75 percent of what a physician is paid under the Official Medical Fee Schedule- Physician Fee Schedule. Maximum fees for NPP assistant-at-surgery services are set according to Section 9789.15.1(c). Maximum fees for services provided by NPPs employed by the physician that are incident to the physician service shall be at 100 percent of the physician fee schedule amount as though the physician personally performed the services.

(c) When a NPP actively assists a physician in performing a surgical procedure and furnishes more than just ancillary services, the NPP's services are eligible for payment as assistant-at-surgery services. Maximum fees for covered NPP assistant-at-surgery services shall be 85 percent of what a physician is paid under the Official Medical Fee Schedule - Physician Fee Schedule. Since physicians are paid at 16 percent of the surgical payment amount for assistant-at-surgery services, the actual payment amount that NPPs receive for assistant-at-surgery services is 13.6 percent of the amount paid to physicians. The AS modifier must be reported when billing NPP assistant-at-surgery services.

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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