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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
§9789.50. Pathology and Laboratory.
(a) Effective for services after January 1, 2004, the maximum reasonable fees
for pathology and laboratory services shall not exceed one hundred twenty (120)
percent of the rate for the same procedure code in the CMS' Clinical Diagnostic
Laboratory Fee Schedule, as established by Sections 1833 and 1834 of the Social
Security Act (42 U.S.C. §§ 1395l and 1395m) and applicable to California.
The Clinical Diagnostic Laboratory Fee Schedule, which can be found on the CMS
Internet Website (http://www.cms.hhs.gov/paymentsystems) is incorporated by reference
and will be made available on the Division of Workers' Compensation's Internet
or upon request to the Administrative Director at:
DIVISION OF WORKERS' COMPENSATION
P.O. BOX 420603
SAN FRANCISCO, CA 94142.
(b) The following procedures in the Special Services and Reports section of
the OMFS 2003 will not be valid for services rendered after January 1, 2004:
CPT Codes 99000, 99001, 99017, 99019, 99020, 99021, 99026, and 99027.
(c) For any pathology and laboratory service not covered by a Medicare payment
system, the maximum reasonable fee paid shall not exceed the fee specified in
the OMFS 2003.
Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference:
Sections 4600, 4603.2 and 5307.1, 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or emergency language will be repealed by operation of law on the following
2. Certificate of Compliance as to 1-2-2004 order, including new subsection
(c), transmitted to OAL 4-30-2004 and filed 6-15-2004 (Register 2004, No. 25).
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