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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5. Application of the Official Medical Fee Schedule (Treatment)

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§9792. Determination of the Fee.

(a) The fee is determined by the use of the Official Medical Fee Schedule as defined in Section 9791.1 of these rules. For services provided on and after January 1, 1994, the conversion factors to be applied to unit values in the schedule are as follows: Determination of the Fee
Evaluation and Management Services Section $7.15
Medicine Section $6.15
Surgery Section $153.00
Radiology Section $12.50
Pathology Section $1.50
Anesthesia Section $34.50

(b) For services in the Evaluation and Management Services Section provided on and after April 1, 1999, the conversion factor to be applied to unit values in the schedule is $8.50.

(c) The conversion factor shall be multiplied by the listed unit value (also known as relative value) of the procedure as set forth in the Official Medical Fee Schedule to establish the reasonable maximum fee. A medical provider or a licensed health care facility may be paid a fee in excess of the reasonable maximum fees if the fee is reasonable, accompanied by itemization, and justified by an explanation of extraordinary circumstances related to the unusual nature of the services rendered; however, in no event shall a physician charge in excess of his or her usual fee.

HISTORY

1. Amendment filed 4-11-79; designated effective 7-1-79 (Register 79, No. 15).

2. Amendment filed 8-14-81; effective thirtieth day thereafter (Register 81, No. 33).

3. Amendment filed 11-5-82; designated effective 1-1-83 (Register 82, No. 45).

4. Amendment filed 11-23-83; effective thirtieth day thereafter (Register 83, No. 48).

5. Amendment filed 8-29-84; effective thirtieth day thereafter (Register 84, No. 35).

6. Editorial correction (Register 84, No. 48).

7. Amendment filed 1-10-85; effective upon filing pursuant to Government Code section 11346.2(d) (Register 85, No. 2).

8. Amendment filed 7-1-87; operative 7-1-87 (Register 87, No. 28).

9. Amendment of section and Note filed 10-7-93; operative 1-1-94 (Register 93, No. 41). This filing is exempt from much of the APA (including OAL review) pursuant to Government Code section 11351.

10. New subsection (a) designator, new subsection (b), and amendment of newly designated subsection (c) filed 2-19-99; operative 4-1-99 (Register 99, No. 8).


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