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Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule -- Services Rendered after January
§9789.20. General Information for Inpatient Hospital Fee Schedule --
Discharge after January 1, 2004
(a) This Inpatient Hospital Fee Schedule section of the Official Medical Fee Schedule covers charges made by a hospital for inpatient services provided by the hospital.
(b) Charges by a hospital for the professional component of medical services for physician services rendered on or after January 1, 2014, shall be paid according to Sections 9789.12.1 through 9789.19. Services rendered on or after July 1, 2004 but before January 1, 2014 shall be paid according to Sections 9789.10 through 9789.11. Services rendered after January 1, 2004 but before July 1, 2004 are governed by the “emergency” regulations that were effective on January 2, 2004. Services rendered on or before January 1, 2004 will be paid according to Section 9790, et seq.
(c) Sections 9789.20 through 9789.25 shall apply to all bills for inpatient services with a date of discharge on or after July 1, 2004. Services for discharges after January 1, 2004, but before July 1, 2004 are governed by the “emergency” regulations that were effective on January 2, 2004. Bills for services with date of admission on or before December 31, 2003 will be reimbursed in accordance with Section 9792.1.
(d) The Inpatient Hospital Fee schedule shall be adjusted to conform to any relevant changes in the Medicare payment schedule, including mid-year changes no later than 60 days after the effective date of those changes. Updates shall be posted on the Division of Workers' Compensation webpage at http://www.dir.ca.gov/DWC/dwc_home_page.htm. The annual updates to the Inpatient Hospital Fee schedule shall be effective every year on December 1.
(e) Any document incorporated by reference in Sections 9789.20 through 9789.25 is available from the Division of Workers' Compensation Internet site (http://www.dir.ca.gov/DWC/dwc_home_page.htm) or upon request to the Administrative Director at:
DIVISION OF WORKERS' COMPENSATION (ATTENTION: OMFS)
Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2, 5307.1, and 5318, Labor Code.
1. New section filed 1-2-2004 as an emergency; operative 1-2-2004 (Register 2004, No. 2). A Certificate of Compliance must be transmitted to OAL by 5-3-2004 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 1-2-2004 order, including amendment of section heading and subsections (c) and (d), transmitted to OAL 4-30-2004 and filed 6-15-2004 (Register 2004, No. 25).
3. Amendment of subsections (c), (d) and (e) filed 12-27-2012; operative 1-1-2013 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2012, No. 52).
4. Amendment of subsection (b) filed 2-4-2015; operative 3-5-2015. Submitted to OAL for printing only pursuant to Government Code section 11340.9 (Register 2015, No. 6).
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