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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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§9789.18.1. Payment for Anesthesia Services - General Payment Rule.

The fee schedule amount for physician anesthesia services is, with the exceptions noted, based on allowable base and time units multiplied by an anesthesia conversion factor and statewide anesthesia GAF. The base unit for each anesthesia procedure is listed in a file entitled “Anesthesia Base Units by CPT Code”, which is released annually by Medicare. The way in which time units are to be calculated is set forth in Section 9789.18.7. The Anesthesia Base Units by CPT Code file and conversion factor are updated by Administrator Director Order. See Section 9789.19 for the file, anesthesia conversion factor, and statewide anesthesia GAF, by date of service.

The maximum reasonable fee for physician and non-physician practitioner anesthesia services shall be calculated as follows:

[Base Unit + Time Unit] * CF * Statewide Anesthesia GAF = Base Maximum Fee

The base maximum fee for the procedure code is the maximum reasonable fee, except as otherwise provided by applicable provisions of this fee schedule, including but not limited to the application of ground rules and modifiers that effect reimbursement.

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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