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Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule
§9789.14. Reimbursement for Reports, Duplicate Reports, Chart Notes.
This section governs reimbursement of all reports other than those which are payable under the medical-legal fee schedule, found at section 9793 et seq.
(a) Treatment Reports Not Separately Reimbursable.
The following treatment reports are not separately reimbursable as the appropriate fee is included within the underlying Evaluation and Management service, Physical Therapy Evaluation service or Occupational Therapy Evaluation service for an office visit:
(1) Doctor's First Report of Occupational Illness or Injury (Form 5021) issued in accordance with section 9785(e). Use Code WC001;
(2) Consultation Reports, except as specified in subdivision (b)(5).
(3) Report by a secondary physician to the primary treating physician.
(4) Physician's Return-to-Work & Voucher Report (DWC-AD 10133.36) issued in accordance with section 9785 subdivision (i) (reimbursement is bundled into payment for PR-3 or PR-4).
(b) Treatment Reports That Are Separately Reimbursable.
The following treatment reports are separately reimbursable.
(1) Primary Treating Physician's Progress Report (Form PR-2), issued in accordance with section 9785(f), using DWC form PR-2, its narrative equivalent, or letter format where allowed by section 9785. Use Code WC002.
(2) Primary Treating Physician's Permanent and Stationary Report (Form PR-3) issued in accordance with section 9785(h). Use Code WC003.
(3) Primary Treating Physician's Permanent and Stationary Report (Form PR-4) issued in accordance with section 9785(h). Use Code WC004.
(4) Psychiatric Report Requested by the WCAB or the Administrative Director, other than a medical-legal report. Use Code WC005, modifier -32.
(5) Consultation Reports that are separately reimbursable. The following reports are separately reimbursable.
(A) Consultation reports requested by the Workers' Compensation Appeals Board or the Administrative Director. Use WC007, modifier -32.
(B) Consultation reports requested by the Qualified Medical Evaluator (“QME”) or Agreed Medical Evaluator (“AME”) in the context of a medical-legal evaluation. Use WC007, modifier -30.
(c) Chart Notes. Requests for chart notes shall be in writing and shall be separately reimbursable. Chart note requests shall be made only by the claims administrator. Use Code WC008 to bill for requested chart notes “By Report”.
(d) Duplicate Reports. A primary treating physician has fulfilled his or her reporting duties by sending one copy of a required report to the claims administrator or to a person designated by the claims administrator to be the recipient of the required report. Requests for duplicate reports related to billings shall be made only by the claims administrator and shall be in writing. Duplicate reports are separately reimbursable. Use Code WC009 to bill for duplicate reports “By Report”.
Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.
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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