Cal. Code Regs. tit. 8 § 9789.12.8
Current through Register 2024 Notice Reg. No. 44, November 1, 2024
The Medicare Status Codes have been adapted for workers' compensation and have the following meanings:
| A = | Active Code. These codes are paid separately under the physician fee schedule. There will be RVUs for codes with this status. |
| B = | Bundled Code. Payment for covered services are always bundled into payment for other services not specified. If RVUs are shown, they are not used for payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient). |
| C = | If payable, these codes will be paid using the RVUs listed in the Centers for Medicare and Medicaid Services (CMS') National Physician Fee Schedule Relative Value File, or if no RVUs are assigned, then by "By Report," generally following review of documentation such as an operative report. |
| E = | If payable: |
| (a) HCPCS codes beginning with "J" or "P", maximum fee is determined according section 9789.13.2. | |
| (b) Other codes are paid under the applicable fee schedule contained in Section 9789.30-9789.70, or if none of those schedules is applicable the code is payable "By Report." | |
| I = | Except as otherwise provided, not valid code for workers' compensation physician billing. See section 9789.12.3. |
| J = | Anesthesia Services. The intent of this value is to facilitate the identification of anesthesia services. There are no RVUs and no payment amounts for these codes in the National Physician Fee Schedule Relative Value File. Instead, the Anesthesia Base Units file is to be used to determine the base units for these codes. |
| M = | Measurement codes. Used for reporting purposes only. |
| N = | If payable, these CPT codes are paid using the listed RVUs; but if no RVUs are listed, then By Report. See section 9789.12.3. |
| P = | Bundled/Excluded Codes. There are no RVUs and no payment amounts for these services. No separate payment should be made for them under the fee schedule. |
| --If the item or service is covered as incident to a physician service and is provided on the same day as a physician service, payment for it is bundled into the payment for the physician service to which it is incident. (An example is an elastic bandage furnished by a physician incident to physician service.) | |
| --If the item or service is covered as other than incident to a physician service, it is excluded from the fee schedule (i.e., colostomy supplies) and should be paid under the other portions of the fee schedule. | |
| Q = | Therapy functional information code (used for required Medicare reporting purposes only; not used for workers' compensation). |
| R = | If payable, these codes will be paid pursuant to section 9789.12.3. |
| T = | Injections. There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. |
| X = | No RVUS or payment amounts are shown for these codes. If payable, these codes are paid under the applicable fee schedule contained in Sections 9789.30 - 9789.70, or if none of those schedules is applicable the code is payable "By Report." (Examples of services payable under another fee schedule are ambulance services and clinical diagnostic laboratory services.) |
Cal. Code Regs. Tit. 8, § 9789.12.8
2. Amendment of table -- items C and N filed 12-26-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 52).
3. Amendment of table adding new item Q filed 3-23-2016; operative 1-1-2016 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 2016, No. 13).
4. Amendment filed 11-6-2018; operative 1-1-2019. Submitted to OAL for filing and printing only pursuant to Government Code section 11340.9(g) (Register 2018, No. 45).
Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.
2. Amendment of table - items C and N filed 12-26-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g)(Register 2013, No. 52).
3. Amendment of table adding new item Q filed 3-23-2016; operative 1/1/2016 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 2016, No. 13).
4. Amendment filed 11-6-2018; operative 1/1/2019. Submitted to OAL for filing and printing only pursuant to Government Code section 11340.9(g) (Register 2018, No. 45).