Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director - Administrative Rules
Article 5.3. Official Medical Fee Schedule

§ 9789.31. Hospital Outpatient Departments and Ambulatory Surgical Centers - Adoption of Standards.

(a) The Administrative Director incorporates by reference, the Centers for Medicare and Medicaid Services' (CMS) Hospital Outpatient Prospective Payment System (HOPPS) certain addenda published in the Federal Register notices announcing revisions in the Medicare payment rates. See Section 9789.39(b) for the adopted payment system addenda by date of service.

(b) For services rendered on or after July 15, 2005, the Administrative Director incorporates by reference, the Centers for Medicare and Medicaid Services' (CMS) Hospital Inpatient Prospective Payment Systems (IPPS) certain tables published in the Federal Register notices announcing revisions in the Medicare payment rates. See Section 9789.39(b) for the adopted payment system tables by date of service.

(c) For services rendered on or after July 15, 2005, the Administrative Director incorporates by reference, the Hospital Inpatient Prospective Payment Systems (IPPS) “Payment Impact File” published by the federal Centers for Medicare & Medicaid Services (CMS) in effect as of the date the Administrative Director Order becomes effective, which document is found at http://www.cms.hhs.gov/AcuteInpatientPPS/.

(d) For services rendered on or after September 1, 2014, but before December 15, 2016, the Administrative Director incorporates by reference, the Medicare Physician Fee Schedule “Relative Value File” published by the federal Centers for Medicare & Medicaid Services (CMS), which document is found at http://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/. See Section 9789.39(b) for the adopted Relative Value File by date of service.

(e) For services rendered on or after December 15, 2016, the Administrative Director incorporates by reference the Centers for Medicare and Medicaid Services' (CMS) Ambulatory Surgical Centers Payment System particular columns of certain addenda published in the Federal Register notices announcing revisions in the Medicare payment rates. See Section 9789.39(b) for the adopted payment system addenda by date of service.

(f) The Administrative Director incorporates by reference certain sections of the Centers for Medicare and Medicaid Services' (CMS) Claims Processing Manual, Chapter 4. See Section 9789.39(b) for the adopted sections of Chapter 4, by date of service.

(g) The Administrative Director incorporates by reference certain sections of the Centers for Medicare and Medicaid Services' Integrated Outpatient Code Editor (I/OCE) CMS Specifications. See Section 9789.39(b) for the adopted sections of I/OCE CMS Specifications, by date of service.

(h) The Administrative Director incorporates by reference the American Medical Associations' “Current Procedural Terminology,” 4th Edition, annual revision in effect as of the date the Administrative Director Order becomes effective. Copies of the Current Procedural Terminology may be purchased from the American Medical Association:

ORDER DEPARTMENT

AMERICAN MEDICAL ASSOCIATION

P.O. BOX 930876

ATLANTA, GA 31193-0876

Or over the internet at:

WWW.AMAPRESS.COM

Or through the American Medical Association's toll free order line:

[phone].

(i) The Administrative Director incorporates by reference CMS' Alphanumeric “Healthcare Common Procedure Coding System (HCPCS)” annual revision in effect as of the date the Administrative Director Order becomes effective. Copies of the Healthcare Common Procedure Coding System (HCPCS) may be purchased from the American Medical Association:

ORDER DEPARTMENT

AMERICAN MEDICAL ASSOCIATION

P.O. BOX 930876

ATLANTA, GA 31193-0876

Or over the internet at:

WWW.AMAPRESS.COM

Or through the American Medical Association's toll free order line:

[phone].

Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.

HISTORY

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 subsection (a), transmitted to OAL 4-30-2004 and filed 6-15-2004 (Register 2004, No. 25).

3. Amendment 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 subsections (c)-(e) filed 3-29-2013; operative 4-1-2013 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2013, No. 13).

5. New subsection (d) and subsection relettering filed 6-3-2014; operative 9-1-2014 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2014, No. 23).

6. Amendment of subsection (d), new subsection (e) and subsection relettering filed 12-15-2016; operative 12-15-2016 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2016, No. 51).

7. New subsections (f) and (g) and subsection relettering filed 5-8-2018; operative 3-15-2018 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2).