Bulletin No. 01-01
December 20, 2001


Newly Adopted Revisions to DWC's Inpatient Hospital Fee Schedule To Remain in Effect Until a New Schedule is Adopted in 2002

 Two new components of DWC's fee schedule for payment of inpatient services at health facilities, which were adopted on June 29, 2001 and had been scheduled to expire on December 31, 2001, have been extended until a new fee schedule is adopted.

 The inpatient hospital fee schedule is contained in Section 9792.1 of the California Code of Regulations.  The  June 29 partial revision of the schedule added Subsection (c) (7), covering reimbursement for implantable hardware and/or instrumentation for back surgeries, and Subsection (c) (8), a methodology for calculating fees in cost outlier (unusually expensive) cases.

 The partial revision also added a sunset provision, Subsection (f),  for these two sections.

 The extension of the effective date was mandated by the enactment of Labor Code Section 5318 earlier this year.  The legislation takes effect January 1, 2002 and extends the sunset date for Subsections (c) (7) and (c) 8 until the effective date of the next full revision of the fee schedule, which is anticipated to occur sometime in 2002.

DWC has forwarded an amendment to Subsection (f), consisting of a clarifying note regarding the legislatively mandated extension of the effective date, to the state Office of Administrative Law for filing with the Secretary of State.

Health facilities, therefore, should continue to use the impantable hardware and cost outlier provisions of Section 9792.1 of the CCR to bill for these inpatient services for workers' compensation patients until a new schedule is adopted.