Article 5.3. Official Medical Fee Schedule

• 8 CA Adc D. 1, Ch. 4.5, Subch. 1, Art. 5.3, Refs & Annos
• § 9789.10. Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014 — Definitions.
• § 9789.11. Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014.
• § 9789.12.1. Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services — for Services Rendered on or After January 1, 2014.
• § 9789.12.2. Calculation of the Maximum Reasonable Fee — Services Other than Anesthesia.
• § 9789.12.3. Status Codes C, I, N and R.
• § 9789.12.4. “by Report” — Reimbursement for Unlisted Procedures/Procedures Lacking RBRVUs.
• § 9789.12.5. Conversion Factors.
• § 9789.12.6. Geographic Health Professional Shortage Area Bonus Payment: Primary Care; Mental Health.
• § 9789.12.7. CMS' National Physician Fee Schedule Relative Value File / Relative Value Units (RVUs).
• § 9789.12.8. Status Codes.
• § 9789.12.9. Professional Component (PC)/Technical Component (TC) Indicator.
• § 9789.12.10. Coding; Current Procedural Terminology, Fourth Edition.
• § 9789.12.11. Evaluation and Management: Coding — New Patient; Established Patient; Documentation.
• § 9789.12.12. Consultation Services Coding — Use of Visit Codes.
• § 9789.12.13. Correct Coding Initiative.
• § 9789.12.14. California Specific Codes.
• § 9789.12.15. California Specific Modifier.
• § 9789.13.1. Supplies.
• § 9789.13.2. Physician-Administered Drugs, Biologicals, Vaccines, Blood Products.
• § 9789.13.3. Physician-Dispensed Drugs.
• § 9789.14. Reimbursement for Reports, Duplicate Reports, Chart Notes.
• § 9789.15.1. Non-Physician Practitioner (NPP) — Payment Methodology.
• § 9789.15.2. Non-Physician Practitioner (NPP) — “Incident to” Services.
• § 9789.15.3. Qualified Non-Physician Anesthetist Services.
• § 9789.15.4. Physical Medicine/Chiropractic/Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure/Modality Services.
• § 9789.15.5. Ophthalmology Multiple Procedure Reduction.
• § 9789.15.6. Diagnostic Cardiovascular Procedures — Multiple Procedure Reduction.
• § 9789.16.1. Surgery — Global Fee.
• § 9789.16.2. Surgery — Billing Requirements for Global Surgeries.
• § 9789.16.3. Surgery — Global Fee — Miscellaneous Rules.
• § 9789.16.4. Surgery — Global Fee; Exception: Circumstances Allowing E&M Code During the Global Period; Primary Treating Physician's Progress Report (PR-2).
• § 9789.16.5. Surgery — Multiple Surgeries and Endoscopies.
• § 9789.16.6. Surgery — Bilateral Surgeries.
• § 9789.16.7. Surgery — CO-Surgeons and Team Surgeons.
• § 9789.16.8. Surgery — Assistants-at-Surgery.
• § 9789.17.1. Radiology Diagnostic Imaging Multiple Procedures.
• § 9789.17.2. Radiology Consultations.
• § 9789.17.3. Additional Payment Reductions for Certain Diagnostic Imaging Services.
• § 9789.18.1. Payment for Anesthesia Services — General Payment Rule.
• § 9789.18.2. Anesthesia — Personally Performed Rate.
• § 9789.18.3. Anesthesia — Medically Directed Rate.
• § 9789.18.4. Anesthesia — Definition of Concurrent Medically Directed Anesthesia Procedures.
• § 9789.18.5. Anesthesia — Medically Supervised Rate.
• § 9789.18.6. Anesthesia — Multiple Anesthesia Procedures.
• § 9789.18.7. Anesthesia — Medical and Surgical Services Furnished in Addition to Anesthesia Procedure.
• § 9789.18.8. Anesthesia — Time and Calculation of Anesthesia Time Units.
• § 9789.18.9. Anesthesia — Base Unit Reduction for Concurrent Medically Directed Procedures.
• § 9789.18.10. Anesthesia — Monitored Anesthesia Care.
• § 9789.18.11. Anesthesia Claims Modifiers.
• § 9789.18.12. Anesthesia and Medical/Surgical Service Provided by the Same Physician.
• § 9789.19. Update Table.
• § 9789.19.1. Table A.
• § 9789.20. General Information for Inpatient Hospital Fee Schedule — Discharge on or After July 1, 2004.
• § 9789.21. Definitions for Inpatient Hospital Fee Schedule.
• § 9789.22. Payment of Inpatient Hospital Services.
• § 9789.23. Hospital Cost to Charge Ratios, Hospital Specific Outliers, and Hospital Composite Factors.
• § 9789.24. Diagnostic Related Groups, Relative Weights, Geometric Mean Length of Stay.
• § 9789.25. Federal Regulations, Federal Register Notices, and Payment Impact File by Date of Discharge.
• § 9789.30. Hospital Outpatient Departments and Ambulatory Surgical Centers — Definitions.
• § 9789.31. Hospital Outpatient Departments and Ambulatory Surgical Centers—Adoption of Standards.
• § 9789.32. Outpatient Hospital Departments and Ambulatory Surgical Centers Fee Schedule — Applicability.
• § 9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule — Determination of Maximum Reasonable Fee.
• § 9789.34. Table A.
• § 9789.35. Table B.
• § 9789.36. Update of Rules to Reflect Changes in the Medicare Payment System.
• § 9789.37. DWC Form 15 Election for High Cost Outlier.
• § 9789.38. Appendix X.
• § 9789.39. Update Table by Date of Service.
• § 9789.40. Pharmacy.
• § 9789.50. Pathology and Laboratory.
• § 9789.60. Durable Medical Equipment, Prosthetics, Orthotics, Supplies.
• § 9789.70. Ambulance Services.
• § 9789.80. Skilled Nursing Facility. [Reserved]
• § 9789.90. Home Health Care. [Reserved]
• § 9789.100. Outpatient Renal Dialysis. [Reserved]
• § 9789.110. Update of Rules to Reflect Changes in the Medicare Payment System.
• § 9789.111. Effective Date of Fee Schedule Provisions.