California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.19 - Update Table

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Services
					 Rendered On or After 1/1/2014.
Documents listed in the following table are incorporated
						by reference and will be made available upon request to the Administrative
						Director.
Document
Services Rendered On or After
								1/1/2014
Adjustment Factors
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factors listed below)
2014 Total RVS adjustment factor: 1.0477
2014 RVU budget neutrality factor: 1.00046
2014 RVU rescaling adjustment factor: 1.04718
2014 Annual increase in the MEI: 1.008
2014 Cumulative adjustment factor: 1.0638
For anesthesia services:
2014 Total RVS adjustment factor: 1.0291
2014 RVU budget neutrality factor: 1.00046
2014 RVU rescaling adjustment factor: 1.04718
2014 anesthesia practice expense adjustment factor:
								0.9823
2014 Annual increase in the MEI: 1.008
2014 Cumulative adjustment factor: 1.0449
Anesthesia Base Units by CPT Code
File name: 2014anesBASEfin
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $11.91
WC003 -- $38.68 for first page
$23.80 each additional page. Maximum of six pages
								absent mutual agreement ($157.68)
WC004 -- $38.68 for first page
$23.80 each additional page. Maximum of seven pages
								absent mutual agreement ($181.48)
WC005 -- $38.68 for first page, $23.80 each
								additional page. Maximum of six pages absent mutual agreement ($157.68)
WC007 -- $38.68 for first page
$23.80 each additional page. Maximum of six pages
								absent mutual agreement ($157.68)
WC008 -- $10.26 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.26 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.13 per x-ray
WC011 -- $10.26 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after 1/1/2014, use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Updated
								10/1/2013."
For services rendered on or after 1/23/2014,
								use:
"Practitioner Services MUE Table -- Updated
								1/1/2014."
For services rendered on or after 4/1/2014, use:
"Practitioner Services MUE Table -- Updated
								4/1/2014."
For services rendered on or after 7/1/2014, use:
"Practitioner Services MUE Table -- Updated
								7/1/2014."
For services rendered on or after 10/1/2014,
								use:
"Practitioner Services MUE Table -- Updated
								10/1/2014."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CMS posts only the most recent version of the
								Practitioner Services MUE Table on the web at:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
.
CCI Edits:
NCCI Policy Manual for Medicare
								Services -- Effective January 1, 2014 [ZIP, 749KB]
National Correct Coding Initiative Policy Manual for
								Medicare Services
Copy of the 1/1/2014 Manual is posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CCI Edits:
For services rendered on or after January 1,
								2014:
Physician CCI Edits
Physician CCI Edits v19.3 (819,852 records). The last
								row contains edit column 1 = 39599 and column 2 = 49570
Physician CCI Edits v19.3 (710,236 records). The
								first row contains edit column 1 = 40490 and column 2 = C8950
For services rendered on or after April 15,
								2014:
Physician CCI Edits v20.1 effective April 1, 2014
								(851,137 records). The last row contains edit column 1 = 39599 and column 2 =
								49570
Physician CCI Edits v20.1 effective April 1, 2014
								(744,393 records). The first row contains edit column 1 = 40490 and column 2 =
								C8950
For services rendered on or after July 1, 2014:
Physician CCI Edits v20.2 effective July 1, 2014
								(863,712 records). The last row contains edit column 1 = 39599 and column 2 =
								49570
Physician CCI Edits v20.2 effective July 1, 2014
								(752,547 records). The first row contains edit column 1 = 40490 and column 2 =
								C8950
For services rendered on or after October 1,
								2014:
Physician CCI Edits v20.3 effective October 1, 2014
								(864,930 records). The last row contains edit column 1 = 39599 and column 2 =
								49570
Physician CCI Edits v20.3 effective October 1, 2014
								(756,576 records). The first row contains edit column 1 = 40490 and column 2 =
								C8950
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2014:
RVU14A [Zip]
* RVUPUF14 (Excluding Attachment A)
* PPRRVU14_V1219
* OPPSCAP_V1219
Excluding:
14LOCCO
ANES 2014_V0103
CY 2014 GPCI _12172013
For services rendered on or after April 15,
								2014:
RVU14B [Zip]
* RVUPUF14 (Excluding Attachment A)
* PPRRVU14_V0324
* OPPSCAP_V0324
Excluding:
14LOCCO
ANES_2014_V0103
CY 2014 GPCI_12172013
For services rendered on or after July 1, 2014:
RVU14C [Zip 3MB]
* RVUPUF14 (Excluding Attachment A)
* PPRRVU14_V0515
* OPPSCAP_V0515
Excluding:
14LOCCO
ANES 2014_V0103
CY 2014 GPCI_12172013
For services rendered on or after October 1,
								2014:
RVU14D [Zip 3MB]
* RVUPUF14 (Excluding Attachment A)
* PPRRVU14_V0815_v4
* OPPSCAP_V0815
Excluding:
14LOCCO
ANES 2014_V0103
CY 2014 GPCI_12172013
CMS Pub 100-04 Medicare Claims Processing: Casting
								and Splint Supplies
For services rendered on or after 1/1/2014, use:
Transmittal 2837 (Change Request 8523)
For services rendered on or after 4/1/2014, use:
the OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor, if any
Anesthesia Conversion Factor: $33.8190
Surgery Conversion Factor: $55.2913
Radiology Conversion Factor: $53.1039
Other Services Conversion Factor: $38.3542
Current Procedural Terminology (CPT®)
CPT 2014
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412 and Surgery CF)
27216 (Use G0413 and Surgery CF)
27217 (Use G0414 and Surgery CF)
27218 (Use G0415 and Surgery CF)
76140 (see §
															9789.17.2)
80100 through 80104 (see clinical lab fee schedule,
								§
															9789.50)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283 and Other Services CF)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456.
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, Number "6" in Column labeled
								"Mult Proc" (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services
								Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1600-FC.html?DLPage=1&DLSort=3&DLSortDir=descending
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, Number "6" in Column labeled
								"Mult Proc" (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services
								Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, Number "6" in Column labeled
								"Mult Proc" (Modifier 51) also Addendum I, Diagnostic Cardiovascular Services
								Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, Number "6" in Column
								labeled "Mult Proc" (Modifier 51) also Addendum I, Diagnostic Cardiovascular
								Services Subject to The Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS
								1600 FC
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2014:
National Physician Fee Schedule Relative Value File
								Calendar Year 2014
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU14A.html?DLPage=1&DLSort=0&DLSortDir=descending
RVUPUF14 (PDF document)
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, RVUPUF14 (PDF document)
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, RVUPUF14 (PDF document)
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, RVUPUF14 (PDF
								document)
Diagnostic Imaging Family Indicator for
								Procedure
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, column AB, labeled,
								"Diagnostic Imaging Family Indicator". Also Addendum F, Diagnostic Imaging
								Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS
								1600 FC
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, column AB, labeled,
								"Diagnostic Imaging Family Indicator". Also Addendum F, Diagnostic Imaging
								Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS
								1600 FC
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, column AB, labeled,
								"Diagnostic Imaging Family Indicator". Also Addendum F, Diagnostic Imaging
								Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS
								1600 FC
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, column AB, labeled,
								"Diagnostic Imaging Family Indicator". Also Addendum F, Diagnostic Imaging
								Service Subject to the Multiple Procedure Payment Reduction (MPPR) CY2014 CMS
								1600 FC
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Health Professional Shortage Area zip code
								data files
2014 Primary Care HPSA [ZIP, 97KB]
2014 Mental Health HPSA [ZIP, 222KB]
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, with PC/TC indicator number
								"5"
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, with PC/TC indicator number
								"5"
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, with PC/TC indicator number
								"5"
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, with PC/TC indicator
								number "5"
Medi-Cal Rates -- DHCS
For services rendered on or after 1/1/2014, use:
Medi-Cal Rates file -- Updated 12/15/2013
For services rendered on or after 1/23/2014,
								use:
Medi-Cal Rates file -- Updated 1/15/2014
For services rendered on or after 2/15/2014,
								use:
Medi-Cal Rates file -- Updated 2/15/2014
For services rendered on or after 3/15/2014,
								use:
Medi-Cal Rates file -- Updated 3/15/2014
For services rendered on or after 6/15/2014,
								use:
Medi-Cal Rates file -- Updated 6/15/2014
For services rendered on or after 7/15/2014,
								use:
Medi-Cal Rates file -- Updated 7/15/2014
For services rendered on or after 8/15/2014,
								use:
Medi-Cal Rates file -- Updated 8/15/2014
For services rendered on or after 9/15/2014,
								use:
Medi-Cal Rates file -- Updated 9/15/2014
For services rendered on or after 10/15/2014,
								use:
Medi-Cal Rates file -- Updated 10/15/2014
For services rendered on or after 11/15/2014,
								use:
Medi-Cal Rates file -- Updated 11/15/2014
For services rendered on or after 12/15/2014,
								use:
Medi-Cal Rates file -- Updated 12/15/2014
For services rendered on or after 1/15/2015,
								use:
Medi-Cal Rates file -- Updated 1/15/2015
For services rendered on or after 2/15/2015,
								use:
Medi-Cal Rates file -- Updated 2/15/2015
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, Number "7" in Column labeled
								"Multiple Procedure" (Modifier 51). Also Addendum J, Diagnostic Ophthalmology
								Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS
								1600 FC
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, Number "7" in Column labeled
								"Multiple Procedure" (Modifier 51). Also Addendum J, Diagnostic Ophthalmology
								Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS
								1600 FC
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, Number "7" in Column labeled
								"Multiple Procedure" (Modifier 51). Also Addendum J, Diagnostic Ophthalmology
								Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS
								1600 FC
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, Number "7" in Column
								labeled "Multiple Procedure" (Modifier 51). Also Addendum J, Diagnostic
								Ophthalmology Services Subject to the Multiple Procedure Payment Reduction
								(MPPR) CY 2014 CMS 1600 FC
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, Number "5" in Column labeled
								"Mult Proc". Also Addendum H, Separately Payable Always Therapy Services
								Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, Number "5" in Column labeled
								"Mult Proc". Also Addendum H, Separately Payable Always Therapy Services
								Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, Number "5" in Column labeled
								"Mult Proc". Also Addendum H, Separately Payable Always Therapy Services
								Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS 1600
								FC
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, Number "5" in Column
								labeled "Mult Proc". Also Addendum H, Separately Payable Always Therapy
								Services Subject to the Multiple Procedure Payment Reduction (MPPR) CY 2014 CMS
								1600 FC
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2014 PFS Physician Time [ZIP, 504KB]
Radiology Diagnostic Imaging Multiple Procedures
For services rendered on or after January 1,
								2014:
RVU14A, PPRRVU14_V1219, number "4" in column S,
								labeled, "Mult Proc"
For services rendered on or after April 15,
								2014:
RVU14B, PPRRVU14_V0324, number "4" in column S,
								labeled, "Mult Proc"
For services rendered on or after July 1, 2014:
RVU14C, PPRRVU14_V0515, number "4" in column S,
								labeled, "Mult Proc"
For services rendered on or after October 1,
								2014:
RVU14D, PPRRVU14_V0815_v4, number "4" in column S,
								labeled, "Mult Proc"
Statewide GAFs (Other than anesthesia)
Average Statewide Work GAF: 1.040
Average Statewide Practice Expense GAF: 1.1606
Average Statewide Malpractice Expense GAF:
								0.6636
Statewide GAF (Anesthesia)
Average Statewide Anesthesia GAF: 1.0313
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation and
								Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
.
(b) Services Rendered On or After 3/1/2015.
					 Documents listed in the following table are incorporated by reference and will
					 be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After March
								1, 2015 & Mid-year Updates
Adjustment Factors
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factors listed below)
2015 Cumulative Relative Value Scale adjustment
								factor: 1.0703
[2015 annual adjustment factor x 2014 cumulative
								adjustment factor = 2015 cumulative adjustment factor (1.006 x 1.0638 =
								1.0703)]
2015 RVS adjustment
								factor[DAGGER]: 0.9981
2015 Annual increase in the MEI: 1.008
2015 Annual adjustment factor: 1.006 (0.9981 x
								1.008)
For anesthesia services:
2015 Anesthesia cumulative adjustment factor:
								1.0461
[2015 anesthesia annual adjustment factor x 2014
								anesthesia cumulative adjustment factor = 2015 cumulative adjustment factor
								(1.001 x 1.0449 = 1.0461)]
2015 Total RVS adjustment
								factor[DAGGER]: 0.9932
2015 RVU budget neutrality factor: 0.9981
2015 Anesthesia practice expense adjustment factor:
								0.99506
2015 Annual increase in the MEI: 1.008
2015 Anesthesia annual adjustment factor: 1.001
BN RVU x Anesthesia PE Adjustment x MEI = (0.9981 x
								0.99506 x 1.008) = 1.001]
[DAGGER]RVS adjustment
								factor for 2015 is 1) the RVU budget neutrality adjustment factor for "all
								services other than anesthesia"; and 2) the product of RVU budget neutrality
								adjustment factor and the anesthesia practice expense adjustment factor for
								anesthesia services.
Anesthesia Base Units by CPT Code
File name: 2014anesBASEfin
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.01
WC003 -- $38.99 for first page
$23.99 each additional page. Maximum of six pages
								absent mutual agreement ($158.94)
WC004 -- $38.99 for first page
$23.99 each additional page. Maximum of seven pages
								absent mutual agreement ($182.93)
WC005 -- $38.99 for first page, $23.99 each
								additional page. Maximum of six pages absent mutual agreement ($158.94)
WC007 -- $38.99 for first page
$23.99 each additional page. Maximum of six pages
								absent mutual agreement ($158.94)
WC008 -- $10.34 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.34 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.17 per x-ray
WC011 -- $10.34 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after March 1, 2015,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								1/1/2015."
For services rendered on or after April 1, 2015,
								use:
"Practitioner Services MUE Table -- Effective
								4/1/2015."
For services rendered on or after July 1, 2015,
								use:
"Practitioner Services MUE Table -- Effective
								7/1/2015."
For services rendered on or after October 1, 2015,
								use:
"Practitioner Services MUE Table -- Effective
								10/1/2015."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CMS posts only the most recent version of the
								Practitioner Services MUE Table on the web at:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
.
CCI Edits:
For services rendered on or after March 1, 2015:
National Correct Coding Initiative Policy Manual for
								Medicare Services
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2015 [ZIP, 1MB]"
Copy of the 2015 Manual is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
For services rendered on or after March 1, 2015:
Physician CCI Edits (Practitioner PTP Edits)
Physician CCI Edits v21.0 effective January 1, 2015
								(898,800 records). The last row contains edit column 1 = 39599 and column 2 =
								49570
Physician CCI Edits v21.0 effective January 1, 2015
								(787,357 records). The first row contains edit column 1 = 40490 and column 2 =
								C8950
For services rendered on or after April 1, 2015:
Practitioner PTP Edits v21.1 effective April 1, 2015
								(899,747 records). The last row contains edits column 1 = 39599 and column 2 =
								49570
Practitioner PTP Edits v21.1 effective April 1, 2015
								(787,520 records). The first row contains edits column 1 = 40490 and column 2 =
								C8950
For services rendered on or after July 1, 2015:
Practitioner PTP Edits v21.2 effective July 1, 2015
								(872,404 records). The last row contains edits column 1 = 39599 and column 2 =
								49570
Practitioner PTP Edits v21.2 effective July 1, 2015
								(821,537 records). The first row contains edits column 1 = 40490 and column 2 =
								00170
For services rendered on or after October 1,
								2015:
Practitioner PTP Edits v21.3 effective October 1,
								2015 (880,855 records). The last row contains edits column 1 = 39599 and column
								2 = 49570
Practitioner PTP Edits v21.3 effective October 1,
								2015 (832,093 records). The first row contains edits column 1 = 40490 and
								column 2 = 00170
Access the Physician CCI Edits on the CMS
								website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Physician CCI Edits excel file maintained
								by CMS contains effective date and deletion date (if any) for each column
								1/column 2 pair. Therefore, the most recent file is the only file posted on the
								CMS website, and covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after March 1, 2015:
RVU15A (Updated 01/08/15) [ZIP, 2MB]
* RVUPUF15 (Excluding Attachment A)
* PPRRVU15_V1223c
* OPPSCAP_V1223
Excluding:
15LOCCO
ANES 2015_V122314
CY2015_GPCIs
For services rendered on or after May 1, 2015:
RVU15B [ZIP, 3MB]
* RVUPUF15 (Excluding Attachment A)
* PPRRVU15_V0213_Current
* OPPSCAP_V0217
Excluding:
15LOCCO
Anes_2015_122314
Anes_Conv_122314_fmt
CY2015_GPCIs
For services rendered on or after July 1, 2015:
RVU15C [ZIP, 5MB] (Except the 0.5% update is not
								adopted)
* RVUPUF15 (Excluding Attachment A)
* PPRRVU15_UP05_V0622
* OPPSCAP_UP05_V0619
Excluding:
15LOCCO
Anes_2015_122314
ANES_2015_UP05_V0701
CY2015_GPCIs
PPRRVU15_UP0.V0515
OPPSCAP_UP0_V0515
For services rendered on or after October 1,
								2015:
RVU15D [ZIP, 5MB] (Except the 0.5% update is not
								adopted)
* RVUPUF15 (Excluding Attachment A)
* PPRRVU15_OCT05_V1001
* OPPSCAP_UP05_V0815
Excluding:
15LOCCO
Anes_2015_122314
ANES_2015_UP05_V0701
CY2015_GPCIs
OPPSCAP_UP0_V0815
PPRRVU15_OCT_V1001
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
Anesthesia Conversion Factor: $31.5290
Surgery Conversion Factor: $51.6570
Radiology Conversion Factor: $50.1900
Other Services Conversion Factor: $40.2970
Current Procedural Terminology (CPT®)
CPT 2015
https://commerce.ama-assn.org/store/
Current Procedural Terminology
Do not use CPT codes:
CPT codes that shall not be used
27215 (Use G0412 and Surgery CF)
27216 (Use G0413 and Surgery CF)
27217 (Use G0414 and Surgery CF)
27218 (Use G0415 and Surgery CF)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code_WC005 code)
97014 (Use G0283 and Other Services CF)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456.
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, Number "6" in Column labeled
								"Mult Proc" (Modifier 51), also listed in CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction Files [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, Number "6" in Column
								labeled "Mult Proc" (Modifier 51), also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, Number "6" in Column
								labeled "Mult Proc" (Modifier 51), also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, Number "6" in Column
								labeled "Mult Proc" (Modifier 51), also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_ Diagnostic Cardiovascular Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
Diagnostic Imaging Family Indicator Description
For services rendered on or after March 1, 2015:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU15A, RVUPUF15 (PDF document)
For services rendered on or after May 1, 2015:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU15B, RVUPUF15 (PDF document)
For services rendered on or after July 1, 2015:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU15C, RVUPUF15 (PDF document)
For services rendered on or after October 1,
								2015:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU15D, RVUPUF15 (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2015 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the
								document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, number "88" in column
								AB, labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2015 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the
								document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, number "88" in column
								AB, labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2015 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the
								document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, number "88" in column
								AB, labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2015 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 44KB], in the
								document CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2015 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, number "4" in column
								S, labeled, "Mult Proc", also listed in CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2015 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2015 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F_Diagnostic Imaging Services Subject To the Multiple
								Procedure Payment Reduction (MPPR)
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Health Professional Shortage Area zip code
								data files
2015 Primary Care HPSA [ZIP, 88KB]
2015 Mental Health HPSA [ZIP, 185KB]
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, with PC/TC indicator number
								"5"
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, with PC/TC indicator
								number "5"
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, with PC/TC indicator
								number "5"
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, with PC/TC indicator
								number "5"
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after March 1, 2015,
								use:
Medi-Cal Rates file -- Updated 2/15/2015
For services rendered on or after March 15, 2015,
								use:
Medi-Cal Rates file -- Updated 3/15/2015
For services rendered on or after April 15, 2015,
								use:
Medi-Cal Rates file -- Updated 4/15/2015
For services rendered on or after May 15, 2015,
								use:
Medi-Cal Rates file -- Updated 5/15/2015
For services rendered on or after June 15, 2015,
								use:
Medi-Cal Rates file -- Updated 6/15/2015
For services rendered on or after July 15, 2015,
								use:
Medi-Cal Rates file -- Updated 7/15/2015
For services rendered on or after August 15, 2015,
								use:
Medi-Cal Rates file -- Updated 8/15/2015
For services rendered on or after September 15, 2015,
								use:
Medi-Cal Rates file -- Updated 9/15/2015
For services rendered on or after October 15, 2015,
								use:
Medi-Cal Rates file -- Updated 10/15/2015
For services rendered on or after November 15, 2015,
								use:
Medi-Cal Rates file -- Updated 11/15/2015
For services rendered on or after December 15, 2015,
								use:
Medi-Cal Rates file -- Updated 12/15/2015
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, Number "7" in Column labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, Number "7" in Column
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, Number "7" in Column
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple
								Procedure Payment Reduction (MPPR)
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, Number "7" in Column
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2015 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 44KB], in the document
								CY_2015_PFS_1612-F Diagnostic Ophthalmology Services Subject to the Multiple
								Procedure Payment Reduction (MPPR)
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after March 1, 2015:
RVU15A, PPRRVU15_V1223c, Number "5" in Column labeled
								"Mult Proc". Also listed in the CY 2015 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F
								Separately Payable Always Therapy Services Subject to the Multiple Procedure
								Payment Reduction (MPPR)
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after May 1, 2015:
RVU15B, PPRRVU15_V0213_Current, Number "5" in Column
								labeled "Mult Proc". Also listed in the CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F
								Separately Payable Always Therapy Services Subject to the Multiple Procedure
								Payment Reduction (MPPR)
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2015:
RVU15C, PPRRVU15_UP05_V0622, Number "5" in Column
								labeled "Mult Proc". Also listed in the CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F
								Separately Payable Always Therapy Services Subject to the Multiple Procedure
								Payment Reduction (MPPR)
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2015:
RVU15D, PPRRVU15_OCT05_V1001, Number "5" in Column
								labeled "Mult Proc". Also listed in the CY 2015 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 44KB] in the document CY_2015_PFS_1612-F
								Separately Payable Always Therapy Services Subject to the Multiple Procedure
								Payment Reduction (MPPR)
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2015 PFS Final Rule Physician Time Updated
								01/20/15 [ZIP 478KB]
Statewide GAFs (Other than anesthesia)
Average Statewide Work GAF: 1.0420
Average Statewide Practice Expense GAF: 1.1621
Average Statewide Malpractice Expense GAF:
								0.7388
Statewide GAF (Anesthesia)
Average Statewide Anesthesia GAF: 1.0391
Splints and Casting Supplies
For services rendered on or after March 1, 2015,
								use:
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation and
								Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
.
(c) Services Rendered On or After 1/1/2016.
					 Documents listed in the following table are incorporated by reference and will
					 be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After January
								1, 2016 & Mid-year Updates
Adjustment Factors
For services rendered on or after January 1,
								2016:
(These factors have been incorporated into the
								conversion factors listed below)
For all services other than anesthesia:
2016 Cumulative adjustment factor: 1.0818
2016 RVU budget neutrality adjustment factor:
								0.9998
2016 Annual increase in the MEI: 1.011
2015 Cumulative "other than anesthesia" adjustment
								1.0703
For anesthesia services:
2016 Cumulative anesthesia adjustment factor:
								1.0527
2016 RVU budget neutrality adjustment factor:
								0.9998
2016 Anesthesia Practice Expense and Malpractice
								adjustment factor: 0.99555
2016 Annual increase in the MEI: 1.011
2015 Cumulative anesthesia adjustment: 1.0461
For services rendered on or after April 1, 2016:
For all services other than anesthesia:
2016 Cumulative adjustment factor: 1.0812
2016 RVU budget neutrality adjustment factor:
								0.99924
2016 Annual increase in the MEI: 1.011
2015 Cumulative "other than anesthesia" adjustment
								1.0703
For anesthesia services:
2016 Cumulative anesthesia adjustment factor:
								1.0317
2016 RVU budget neutrality adjustment factor:
								0.99924
2016 Anesthesia Practice Expense and Malpractice
								adjustment factor: 0.97628
2016 Annual increase in the MEI: 1.011
2015 Cumulative anesthesia adjustment: 1.0461
Anesthesia Base Units by CPT Code
File name: 2014anesBASEfin
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.14
WC003 -- $39.42 for first page
$24.25 each additional page. Maximum of six pages
								absent mutual agreement ($160.69)
WC004 -- $39.42 for first page
$24.25 each additional page. Maximum of seven pages
								absent mutual agreement ($184.94)
WC005 -- $39.42 for first page, $24.25 each
								additional page. Maximum of six pages absent mutual agreement ($160.69)
WC007 -- $39.42 for first page
$24.25 each additional page. Maximum of six pages
								absent mutual agreement ($160.69)
WC008 -- $10.45 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.45 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.23 per x-ray
WC011 -- $10.45 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after January 1, 2016,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								1/1/2016."
For services rendered on or after April 1, 2016,
								use:
"Practitioner Services MUE Table -- Effective
								4/1/2016."
For services rendered on or after July 1, 2016,
								use:
"Practitioner Services MUE Table -- Effective
								7/1/2016."
For services rendered on or after October 1, 2016,
								use:
"Practitioner Services MUE Table -- Effective
								10/1/2016."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CMS posts only the most recent version of the
								Practitioner Services MUE Table on the web at:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
CCI Edits:
For services rendered on or after January 1,
								2016:
National Correct Coding Initiative Policy Manual for
								Medicare Services
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2016 [ZIP, 761MB]"
Copy of the 2016 Manual is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
For services rendered on or after January 1,
								2016:
Physician CCI Edits (Practitioner PTP Edits)
Practitioner PTP Edits v22.0 effective January 1,
								2016 (903,287 records). The last row contains edits column 1 = 39599 and column
								2 = 49570
Practitioner PTP Edits v22.0 effective January 1,
								2016 (866,823 records). The first row contains edits column 1 = 40490 and
								column 2 = 00170
For services rendered on or after April 1, 2016:
Practitioner PTP Edits v22.1 effective April 1, 2016
								(914,985 records). The last row contains edits column 1 = 39599 and column 2 =
								49570
Practitioner PTP Edits v22.1 effective April 1, 2016
								(877,109 records). The first row contains edits column 1 = 40490 and column 2 =
								00170
For services rendered on or after July 1, 2016
Practitioner PTP Edits v22.2 effective July 1, 2016
								(915,436 records). The last row contains edits column 1 = 39599 and column 2 =
								49570
Practitioner PTP Edits v22.2 effective July 1, 2016
								(877,847 records). The first row contains edits column 1 = 40490 and column 2 =
								00170
For services rendered on or after October 1,
								2016:
Practitioner PTP Edits v22.3 effective October 1,
								2016 (668,511 records) 0001M/36591 -- 29999/G0354
Practitioner PTP Edits v22.3 effective October 1,
								2016 (498,018 records) 30000/0213T -- 49999/49570
Practitioner PTP Edits v22.3 effective October 1,
								2016 (489,682 records) 50010/0213T -- 79999/90784
Practitioner PTP Edits v22.3 effective October 1,
								2016 (179,162 records) 80003/80002 -- R0075/R0070
Access the Physician CCI Edits on the CMS
								website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Physician CCI Edits excel file maintained
								by CMS contains effective date and deletion date (if any) for each column
								1/column 2 pair. Therefore, the most recent file is the only file posted on the
								CMS website, and covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2016:
RVU16A (Released January 2016) [ZIP, 3MB]
* RVUPUF16 (Excluding Attachment A)
* PPRRVU16_V0122
* OPPSCAP_V0105
Excluding:
16LOCCO
ANES_V0105
CY2016_GPCIs
For services rendered on or after April 1, 2016:
RVU16B (April 2016 release) [ZIP, 3MB]
* RVUPUF16 (Excluding Attachment A)
* PPRRVU16_April_V0202
* OPPSCAP_V0215
Excluding:
16LOCCO
ANES_V0105
CY2016_GPCIs
For services rendered on or after July 1, 2016:
RVU16C (July 2016 release) [ZIP, 3MB]
* RVUPUF16 (Excluding Attachment A)
* PPRRVU16_V0517
* OPPSCAP_V0515
Excluding:
16LOCCO
ANES_V0105
CY2016_GPCIs
For services rendered on or after October 1,
								2016:
RVU16D [ZIP, 3MB]
* RVUPUF16 (Excluding Attachment A)
* PPRRVU16_V0804
* OPPSCAP_V0815
Excluding:
16LOCCO
ANES_V0105
CY2016_GPCIs
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
For services rendered on or after January 1,
								2016:
Anesthesia Conversion Factor: $29.3852
Surgery Conversion Factor: $48.2013
Radiology Conversion Factor: $47.4598
Other Services Conversion Factor: $42.4599
For services rendered on or after April 1, 2016:
Anesthesia Conversion Factor: $28.8003
Surgery Conversion Factor: $48.1743
Radiology Conversion Factor: $47.4332
Other Services Conversion Factor: $42.4361
Current Procedural Terminology (CPT®)
CPT 2016
https://commerce.ama-assn.org/store/
Current Procedural Terminology
Do not use CPT codes:
CPT codes that shall not be used
27215 (Use G0412 and Surgery CF)
27216 (Use G0413 and Surgery CF)
27217 (Use G0414 and Surgery CF)
27218 (Use G0415 and Surgery CF)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code_WC005 code)
97014 (Use G0283 and Other Services CF)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document
								CMS-1631-FC_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document
								CMS-1631-FC_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document
								CMS-1631-FC_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction Files [Zip, 39KB], in the document
								CMS-1631-FC_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2016:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU16A, RVUPUF16 (PDF document)
For services rendered on or after April 1, 2016:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU16B, RVUPUF16 (PDF document)
For services rendered on or after July 1, 2016:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU16C, RVUPUF16 (PDF document)
For services rendered on or after October 1,
								2016:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU16D, RVUPUF16 (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2016 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, number "88" in column
								AB, labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2016 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2016 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2016 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								document CMS-1631-FC_Diagnostic Imaging Services Subject to MPPR
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2016 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2016 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2016 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2016 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 39KB], in the document CMS-1631-FC_Diagnostic
								Imaging Services Subject to MPPR
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Health Professional Shortage Area zip code
								data files
2016 Primary Care HPSA [ZIP, 99KB]
2016 Mental Health HPSA [ZIP, 239KB]
Access the files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after January 1, 2016,
								use:
Medi-Cal Rates file -- Updated 12/15/2015
For services rendered on or after January 15, 2016,
								use:
Medi-Cal Rates file -- Updated 1/15/2016
For services rendered on or after February 15, 2016,
								use:
Medi-Cal Rates file -- Updated 2/15/2016
For services rendered on or after March 15, 2016,
								use:
Medi-Cal Rates file -- Updated 3/15/2016
For services rendered on or after April 15, 2016,
								use:
Medi-Cal Rates file -- Updated 4/15/2016
For services rendered on or after May 15, 2016,
								use:
Medi-Cal Rates file -- Updated 5/15/2016
For services rendered on or after June 15, 2016,
								use:
Medi-Cal Rates file -- Updated 6/15/2016
For services rendered on or after July 15, 2016,
								use:
Medi-Cal Rates file -- Updated 7/15/2016
For services rendered on or after August 15, 2016,
								use:
Medi-Cal Rates file -- Updated 8/15/2016
For services rendered on or after September 15, 2016,
								use:
Medi-Cal Rates file -- Updated 9/15/2016
For services rendered on or after October 15, 2016,
								use:
Medi-Cal Rates file -- Updated 10/15/2016
For services rendered on or after November 15, 2016,
								use:
Medi-Cal Rates file -- Updated 11/15/2016
For services rendered on or after December 15, 2016,
								use:
Medi-Cal Rates file -- Updated 12/15/2016
For services rendered on or after January 15, 2017,
								use:
Medi-Cal Rates file -- Updated 1/15/2017
For services rendered on or after February 15, 2017,
								use:
Medi-Cal Rates file -- Updated 2/15/2017
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2016 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 39KB], in the
								CMS-1631-FC_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2016:
RVU16A, PPRRVU16_V0122, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2016 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 39KB] in the document
								CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2016:
RVU16B, PPRRVU16_April_V0202, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2016 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 39KB] in the document
								CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2016:
RVU16C, PPRRVU16_V0517, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2016 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 39KB] in the document
								CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2016:
RVU16D, PPRRVU16_V0804, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2016 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 39KB] in the document
								CMS-1631-FC_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2016 PFS Final Rule Work Time [ZIP 220KB]
Statewide GAFs (Other than anesthesia)
Average Statewide Work GAF: 1.0420
Average Statewide Practice Expense GAF: 1.1621
Average Statewide Malpractice Expense GAF:
								0.7388
Statewide GAF (Anesthesia)
Average Statewide Anesthesia GAF: 1.0487
Splints and Casting Supplies
For services rendered on or after January 1, 2016,
								use:
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation and
								Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
(d) Services Rendered On or After 3/1/2017.
					 Documents listed in the following table are incorporated by reference and will
					 be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After March
								1, 2017 & Mid-year Updates
Adjustment Factors
For services rendered on or after March 1, 2017:
(These factors have been incorporated into the
								conversion factors listed below)
For all services other than anesthesia:
2017 Cumulative adjustment factor: 1.0933
2017 RVU budget neutrality adjustment factor:
								0.99987
2017 Imaging MPPR adjustment factor: 0.9993
2017 Annual increase in the MEI: 1.012
2016 Cumulative "other than anesthesia" adjustment:
								1.0812
For anesthesia services:
2017 Cumulative anesthesia adjustment factor:
								1.0433
2017 RVU budget neutrality adjustment factor:
								0.99987
2017 Imaging MPPR adjustment factor: 0.9993
2017 Annual increase in the MEI: 1.012
2016 Cumulative anesthesia adjustment: 1.0317
Anesthesia Base Units by CPT Code
File name: 2014anesBASEfin
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.29
WC003 -- $39.89 for first page
$24.54 each additional page. Maximum of six pages
								absent mutual agreement ($162.59)
WC004 -- $39.89 for first page
$24.54 each additional page. Maximum of seven pages
								absent mutual agreement ($187.13)
WC005 -- $39.89 for first page, $24.54 each
								additional page. Maximum of six pages absent mutual agreement ($162.59)
WC007 -- $39.89 for first page
$24.54 each additional page. Maximum of six pages
								absent mutual agreement ($162.59)
WC008 -- $10.58 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.58 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.29 per x-ray
WC011 -- $10.58 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after March 1, 2017,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								1/1/2017."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after April 1, 2017,
								use:
"Practitioner Services MUE Table -- Effective
								4/1/2017."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after July 1, 2017,
								use:
"Practitioner Services MUE Table -- Effective
								7/1/2017."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after October 1, 2017,
								use:
"Practitioner Services MUE Table -- Effective
								10/1/2017."
Copies of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CMS posts only the most recent version of the
								Practitioner Services MUE Table on the web at:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
CCI Edits:
For services rendered on or after March 1, 2017:
National Correct Coding Initiative Policy Manual for
								Medicare Services
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2017 [ZIP, 770KB]"
Copy of the 2017 Manual is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
For services rendered on or after March 1, 2017:
Physician CCI Edits (Practitioner PTP Edits)
Practitioner PTP Edits v23.0 effective January 1,
								2017
(422,052 records) 0001M/36591 -- 24940/G0471
Practitioner PTP Edits v23.0 effective January 1,
								2017
(574,135 records) 25000/01810 -- 39599/49570
Practitioner PTP Edits v23.0 effective January 1,
								2017
(436,857 records) 40490/00170 -- 59897/G0347
Practitioner PTP Edits v23.0 effective January 1,
								2017
(501,820 records) 60000/0213T -- R0075/R0070
For services rendered on or after April 1, 2017:
Practitioner PTP Edits v23.1 effective April 1,
								2017
(474,500 records) 0001M/36591 -- 25931/G0471
Practitioner PTP Edits v23.1 effective April 1,
								2017
(502,046 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v23.1 effective April 1,
								2017
(495,097 records) 37140/0213T -- 60650/G0471
Practitioner PTP Edits v23.1 effective April 1,
								2017
(501,223 records) 61000/0213T -- R0075/R0070
For services rendered on or after July 1, 2017:
Practitioner PTP Edits v23.2 effective July 1,
								2017
(476,159 records) 0001M/36591 -- 25931/G0471 [ZIP,
								13MB]
Practitioner PTP Edits v23.2 effective July 1,
								2017
(502,166 records) 26010/01810 -- 36909/J2001 [ZIP,
								13MB]
Practitioner PTP Edits v23.2 effective July 1,
								2017
(495,291 records) 37140/0213T -- 60650/G0471 [ZIP,
								13MB]
Practitioner PTP Edits v23.2 effective July 1,
								2017
(503,693 records) 61000/0213T -- R0075/R0070 [ZIP,
								13MB]
For services rendered on or after October 1,
								2017:
Practitioner PTP Edits v23.3 effective October 1,
								2017
(476,064 records) 0001M/36591 -- 25931/G0471
Practitioner PTP Edits v23.3 effective October 1,
								2017
(502,759 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v23.3 effective October 1,
								2017
(495,446 records) 37140/0213T -- 60650/G0471
Practitioner PTP Edits v23.3 effective October 1,
								2017
(504,589 records) 61000/0213T -- R0075/R0070
Access the Physician CCI Edits on the CMS website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Physician CCI Edits excel file maintained
								by CMS contains effective date and deletion date (if any) for each column
								1/column 2 pair. Therefore, the most recent file is the only file posted on the
								CMS website, and covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after March 1, 2017:
RVU17A (January 2017 release) [ZIP, 3MB]
* RVU17A (Excluding Attachment A)
* PPRRVU17_V1219
* OPPSCAP_V1219
Excluding:
17LOCCO
ANES_V0101
CY2017_GPCIs
For services rendered on or after April 1, 2017:
RVU17B [ZIP, 3MB]
* RVU17B (Excluding Attachment A)
* PPRRVU17_V0209
* OPPSCAP_V0215
Excluding:
17LOCCO
ANES_V0101
CY2017_GPCIs
For services rendered on or after July 1, 2017:
RVU17C [ZIP, 3MB]
* RVU17C (Excluding Attachment A)
* PPRRVU17_JULY_V0503
* OPPSCAP_V0515
Excluding:
17LOCCO
ANES_V0101
CY2017_GPCIs
For services rendered on or after October 1,
								2017:
RVU17D [ZIP, 3MB]
* RVUPUF17 (Excluding Attachment A)
* PPRRVU17_OCT
* OPPSCAP_OCT
Excluding:
17LOCCO
ANES_OCT
CY2017_GPCIs
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
For services rendered on or after March 1, 2017:
Anesthesia Conversion Factor: $26.8011
Other Services Conversion Factor: $44.6572
Current Procedural Terminology (CPT®)
CPT 2017
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the document
								CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the document
								CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, Number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the document
								CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, Number "6" in column S, labeled
								"Mult Proc" (Modifier 51), also listed in CY 2017 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 42KB], in the document
								CMS-1654-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after March 1, 2017:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU17A, RVU17A (PDF document)
For services rendered on or after April 1, 2017:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU17B, RVU17B (PDF document)
For services rendered on or after July 1, 2017:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU17C, RVU17C (PDF document)
For services rendered on or after October 1,
								2017:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU17D, RVUPUF17 (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2017 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2017 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, number "88" in column
								AB, labeled, "Diagnostic Imaging Family Indicator", also listed in CY 2017 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2017 PFS
								Final Rule Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								document CMS-1654-F_Diagnostic Imaging Services Subject to MPPR
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2017 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2017 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, number "4" in column S,
								labeled, "Mult Proc", also listed in CY 2017 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2017 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 42KB], in the document CMS-1654-F_Diagnostic
								Imaging Services Subject to MPPR
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Health Professional Shortage Area zip code
								data files
2017 Primary Care HPSA [ZIP, 99KB]
2017 Mental Health HPSA [ZIP, 237KB]
Access the files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, number "5" in column N,
								labeled, "PCTC IND", (PC/TC Indicator)
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after March 1, 2017
								use:
Medi-Cal Rates file -- Updated 2/15/2017
For services rendered on or after March 15, 2017,
								use:
Medi-Cal Rates file -- Updated 3/15/2017
For services rendered on or after April 15, 2017,
								use:
Medi-Cal Rates file -- Updated 4/15/2017
For services rendered on or after May 15, 2017,
								use:
Medi-Cal Rates file -- Updated 5/15/2017
For services rendered on or after June 15, 2017,
								use:
Medi-Cal Rates file -- Updated 6/15/2017
For services rendered on or after July 15, 2017,
								use:
Medi-Cal Rates file -- Updated 7/15/2017
For services rendered on or after August 15, 2017,
								use:
Medi-Cal Rates file -- Updated 8/15/2017
For services rendered on or after September 15, 2017,
								use:
Medi-Cal Rates file -- Updated 9/15/2017
For services rendered on or after October 15, 2017,
								use:
Medi-Cal Rates file -- Updated 10/15/2017
For services rendered on or after November 15, 2017,
								use:
Medi-Cal Rates file -- Updated 11/15/2017
For services rendered on or after December 15, 2017,
								use:
Medi-Cal Rates file -- Updated 12/15/2017
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, Number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2017 PFS Final Rule
								Multiple Procedure Payment Reduction File [Zip, 42KB], in the
								CMS-1654-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, Number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2017 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 42KB], in the CMS-1654-F_Diagnostic
								Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after March 1, 2017:
RVU17A, PPRRVU17_V1219, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2017 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 42KB] in the document
								CMS-1654-F_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2017:
RVU17B, PPRRVU17_V0209, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2017 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 42KB] in the document
								CMS-1654-F_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2017:
RVU17C, PPRRVU17_JULY_V0503, Number "5" in column S,
								labeled "Mult Proc". Also listed in the CY 2017 PFS Final Rule Multiple
								Procedure Payment Reduction File [Zip, 42KB] in the document
								CMS-1654-F_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2017:
RVU17D, PPRRVU17_OCT, Number "5" in column S, labeled
								"Mult Proc." Also listed in the CY 2017 PFS Final Rule Multiple Procedure
								Payment Reduction File [Zip, 42KB] in the document CMS-1654-F_Separately
								Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2017 PFS Final Rule Physician Time [ZIP,
								628KB]
Statewide GAFs (Other than anesthesia)
Average Statewide Work GAF: 1.0417
Average Statewide Practice Expense GAF: 1.1632
Average Statewide Malpractice Expense GAF:
								0.6632
Statewide GAF (Anesthesia)
Average Statewide Anesthesia GAF: 1.0374
Splints and Casting Supplies
For services rendered on or after March 1, 2017,
								use:
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation and
								Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
(e) Services Rendered On or After 1/1/2018.
					 Documents listed in the following table are incorporated by reference and will
					 be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After January
								1, 2018 & Midyear Updates
Adjustment Factors (These factors have been
								incorporated into the conversion factors listed below)
For services rendered on or after January 1,
								2018:
For all services other than anesthesia:
2018 Cumulative adjustment factor: 1.1075
2018 RVU budget neutrality adjustment factor:
								0.9990
2018 Annual increase in the MEI: 1.014
2017 Cumulative "other than anesthesia" adjustment:
								1.0933
For anesthesia services:
2018 Cumulative anesthesia adjustment factor:
								1.0604
2018 RVU budget neutrality adjustment factor:
								0.9990
2018 Annual increase in the MEI: 1.014
2018 Anesthesia practice expense and malpractice
								adjustment factor: 1.0034
2017 Cumulative anesthesia adjustment: 1.0433
Anesthesia Base Units by CPT Code
File name:
cms1676f_cy_2018_anesthesia_base_units.xlsx
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.46
WC003 -- $40.45 for first page
$24.88 each additional page. Maximum of six pages
								absent mutual agreement ($164.85)
WC004 -- $40.45 for first page
$24.88 each additional page. Maximum of seven pages
								absent mutual agreement ($189.73)
WC005 -- $40.45 for first page, $24.88 each
								additional page. Maximum of six pages absent mutual agreement ($164.85)
WC007 -- $40.45 for first page
$24.88 each additional page. Maximum of six pages
								absent mutual agreement ($164.85)
WC008 -- $10.73 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.73 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.36 per x-ray
WC011 -- $10.73 per scan
WC012 -- No Fee Prescribed / Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after January 1, 2018,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								1/1/18."
Copy of the MUE Table is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after April 1, 2018,
								use:
"Practitioner Services MUE Table -- Effective
								4/1/18"
Copy of the MUE Table is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after July 1, 2018,
								use:
"Practitioner Services MUE Table -- Effective
								07-01-2018 [ZIP, 346KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
Excerpts of the MUE Table is posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
For services rendered on or after October 1, 2018,
								use:
"Practitioner Services MUE Table -- Effective
								10-01-2018 [ZIP, 348KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
Excerpts of the MUE Table is posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
CCI Edits:
For services rendered on or after January 1,
								2018:
National Correct Coding Initiative Policy Manual for
								Medicare Services
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2018 [ZIP, 851KB]"
Copy of the 2018 Manual is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
For services rendered on or after January 1,
								2018:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v24.0 effective January 1,
								2018
(511,599 records) 0001M/36591 -- 25931/G0471
Practitioner PTP Edits v24.0 effective January 1,
								2018
(507,927 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v24.0 effective January 1,
								2018
(474,903 records) 37140/0213T -- 60650/G0471
Practitioner PTP Edits v24.0 effective January 1,
								2018
(514,837 records) 61000/0213T -- R0075/R0070
For services rendered on or after April 1, 2018:
Practitioner PTP Edits v24.1 effective April 1,
								2018
(537,183 records) 0001M/36591 -- 25931/G0471
Practitioner PTP Edits v24.1 effective April 1,
								2018
(482,358 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v24.1 effective April 1,
								2018
(523,111 records) 37140/0213T -- 60650/G0471
Practitioner PTP Edits v24.1 effective April 1,
								2018
(466,820 records) 61000/0213T -- R0075/R0070
For services rendered on or after July 1, 2018:
Practitioner PTP Edits v24.2 effective July 1,
								2018
(539,120 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v24.2 effective July 1,
								2018
(482,378 records) 27000/01995 -- 37790/G0471
Practitioner PTP Edits v24.2 effective July 1,
								2018
(523,129 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v24.2 effective July 1,
								2018
(467,725 records): 62000/0213T -- R0075/R0070
For services rendered on or after October 1,
								2018:
Practitioner PTP Edits v24.3 effective October 1,
								2018
(539,717 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v24.3 effective October 1,
								2018
(482,493 records) 27000/01995 -- 37790/G0471
Practitioner PTP Edits v24.3 effective October 1,
								2018
(523,504 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v24.3 effective October 1,
								2018
(467,777 records): 62000/0213T -- R0075/R0070
Access the Practitioner PTP Edits on the CMS website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file is the only file posted
								on the CMS website, and covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2018:
RVU18A (Updated 12/20/2017) [ZIP, 3MB]
* RVU18A (Excluding Attachment A)
* PPRRVU18_JAN
* OPPSCAP_JAN
Excluding:
18LOCCO
ANES2018
GPCI2018
For services rendered on or after April 1, 2018:
RVU18B [ZIP, 3MB]
* RVU18B (Excluding Attachment A)
* PPRRVU18_APR
* OPPSCAP_APR
Excluding:
18LOCCO
ANES2018
GPCI2018
For services rendered on or after July 1, 2018:
RVU18C1 [ZIP, 3MB]
* RVU18C (Excluding Attachment A)
* PPRRVU18_JUL
* OPPSCAP_JUL
Excluding:
18LOCCO
ANES2018
GPCI2018
For services rendered on or after October 1,
								2018:
RVU18D [ZIP, 3MB]
* RVU18D (Excluding Attachment A)
* PPRRVU18_OCT
* OPPSCAP_OCT
Excluding:
18LOCCO
ANES2018
GPCI2018
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
For services rendered on or after January 1,
								2018:
Anesthesia Conversion Factor: $27.2415
Other Services Conversion Factor: $45.2371
Current Procedural Terminology (CPT®)
CPT 2018
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code_WC005 code)
97014 (Use G0283)
97127 (Use G0515)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "6" in column S, labeled
								"Mult Proc" (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "6" in column S, labeled
								"Mult Proc" (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2018 PFS Final Rule
								Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "6" in column S, labeled
								"Mult Proc" (Modifier 51), also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2018:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU18A, RVU18A (PDF document)
For services rendered on or after April 1, 2018:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU18B, RVU18B (PDF document)
For services rendered on or after July 1, 2018:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU18C1, RVU18C (PDF document)
For services rendered on or after October 1,
								2018:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU18D, RVU18D (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2018 PFS
								Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the
								document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2018 PFS
								Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the
								document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2018 PFS
								Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the
								document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2018 PFS
								Final Rule Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the
								document CMS-1676-F_Diagnostic Imaging Services Subject to MPPR
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2018 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2018 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2018 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2018 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Diagnostic
								Imaging Services Subject to MPPR
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Health Professional Shortage Area zip code
								data files
2018 Primary Care HPSA [ZIP, 98KB]
2018 Mental Health HPSA [ZIP, 218KB]
Access the files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query
(By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after January 1, 2018,
								use:
Medi-Cal Rates file -- Updated 12/15/2017
For services rendered on or after January 15, 2018,
								use:
Medi-Cal Rates file -- Updated 1/15/2018
For services rendered on or after February 15, 2018,
								use:
Medi-Cal Rates file -- Updated 2/15/2018
For services rendered on or after March 15, 2018,
								use:
Medi-Cal Rates file -- Updated 3/15/2018
For services rendered on or after April 15, 2018,
								use:
Medi-Cal Rates file -- Updated 4/15/2018
For services rendered on or after May 15, 2018,
								use:
Medi-Cal Rates file -- Updated 5/15/2018
For services rendered on or after June 15, 2018,
								use:
Medi-Cal Rates file -- Updated 6/15/2018
For services rendered on or after July 15, 2018,
								use:
Medi-Cal Rates file -- Updated 7/15/2018
For services rendered on or after August 15, 2018,
								use:
Medi-Cal Rates file -- Updated 8/15/2018
For services rendered on or after September 15, 2018,
								use:
Medi-Cal Rates file -- Updated 9/15/2018
For services rendered on or after October 15, 2018,
								use:
Medi-Cal Rates file -- Updated 10/15/2018
For services rendered on or after November 15, 2018,
								use:
Medi-Cal Rates file -- Updated 11/15/2018
For services rendered on or after December 15, 2018,
								use:
Medi-Cal Rates file -- Updated 12/15/2018
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2018 PFS Final Rule
								Multiple Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2018 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 42KB], in the document
								CMS-1676-F_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2018:
RVU18A, PPRRVU18_JAN, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2018:
RVU18B, PPRRVU18_APR, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2018:
RVU18C1, PPRRVU18_JUL, number "5" in column S,
								labeled "Mult Proc." Also listed in CY 2018 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately
								Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2018:
RVU18D, PPRRVU18_OCT, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2018 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 42KB], in the document CMS-1676-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2018 PFS Final Rule Physician Time [ZIP,
								591KB]
Statewide GAFs (Other than anesthesia)
Average Statewide Work GAF: 1.041
Average Statewide Practice Expense GAF: 1.166
Average Statewide Malpractice Expense GAF: 0.605
Statewide GAF (Anesthesia)
Average Statewide Anesthesia GAF: 1.034
Splints and Casting Supplies
For services rendered on or after January 1, 2018,
								use:
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
(f) Services Rendered On or After January 1,
					 2019. Documents listed in the following table are incorporated by reference and
					 will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After January
								1, 2019 & Mid-year Updates
Adjustment Factors (These factors have been
								incorporated into the conversion factors listed below)
For all services other than anesthesia:
2019 Cumulative adjustment factor: 1.1226
2019 RVU budget neutrality adjustment factor:
								0.9986
2019 Annual increase in the MEI: 1.015
2018 Cumulative "other than anesthesia" adjustment:
								1.1075
For anesthesia services:
2019 Cumulative anesthesia adjustment factor:
								1.0777
2019 RVU budget neutrality adjustment factor:
								0.9986
2019 Annual increase in the MEI: 1.015
2019 Anesthesia practice expense and malpractice
								adjustment factor: 1.0027
2018 Cumulative anesthesia adjustment: 1.0604
Anesthesia Base Units by CPT Code
File name:
cms1676f_cy_2018_anesthesia_base_units.xlsx
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.65
WC003 -- $41.06 for first page
$25.25 each additional page. Maximum of six pages
								absent mutual agreement ($167.31)
WC004 -- $41.06 for first page
$25.25 each additional page. Maximum of seven pages
								absent mutual agreement ($192.56)
WC005 -- $41.06 for first page, $25.25 each
								additional page. Maximum of six pages absent mutual agreement ($167.31)
WC007 -- $41.06 for first page
$25.25 each additional page. Maximum of six pages
								absent mutual agreement ($167.31)
WC008 -- $10.89 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $10.89 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.44 per x-ray
WC011 -- $10.89 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after January 1, 2019,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								01-01-2019 [ZIP, 350KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
For services rendered on or after April 1, 2019,
								use:
"Practitioner Services MUE Table -- Effective
								04-01-2019 [ZIP, 351KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
For services rendered on or after July 1, 2019,
								use:
"Practitioner Services MUE Table -- Effective
								07-01-2019 [ZIP, 354KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
For services rendered on or after October 1, 2019,
								use:
"Practitioner Services MUE Table -- Effective
								10-01-2019 [ZIP, 354KB]," excluding all codes listed with Practitioner Services
								MUE Value of "0" (zero).
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2019 [ZIP, 1MB]"
National Correct Coding Initiative Policy Manual for
								Medicare Services
Copy of the 2019 Manual is posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
For services rendered on or after January 1,
								2019:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v25.0 effective January 1,
								2019
(556,965 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v25.0 effective January 1,
								2019
(489,643 records) 27000/01995 -- 37790/G0471
Practitioner PTP Edits v25.0 effective January 1,
								2019
(529,244 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v25.0 effective January 1,
								2019
(483,364 records): 62000/0213T -- R0075/R0070
For services rendered on or after April 1, 2019:
Practitioner PTP Edits v25.1 effective April 1,
								2019
(556,965 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v25.1 effective April 1,
								2019
(489,643 records) 27000/01995 -- 37790/G0471
Practitioner PTP Edits v25.1 effective April 1,
								2019
(529,244 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v25.1 effective April 1,
								2019
(483,364 records): 62000/0213T -- R0075/R0070
For services rendered on or after July 1, 2019:
Practitioner PTP Edits v25.2 effective July 1,
								2019
(561,060 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v25.2 effective July 1,
								2019
(491,324 records) 27000/01995 -- 37799/96523
Practitioner PTP Edits v25.2 effective July 1,
								2019
(531,167 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v25.2 effective July 1,
								2019
(489,591 records): 62000/0213T -- R0075/R0070
For services rendered on or after October 1,
								2019:
Practitioner PTP Edits v25.3 effective October 1,
								2019
(561,144 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v25.3 effective October 1,
								2019
(491,337 records) 27000/01995 -- 37799/96523
Practitioner PTP Edits v25.3 effective October 1,
								2019
(531,167 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v25.3 effective October 1,
								2019
(489,612 records): 62000/0213T -- R0075/R0070
Access the Practitioner PTP Edits on the CMS website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file is the only file posted
								on the CMS website, and covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2019:
RVU19A (updated file 12/20/18) [ZIP, 3MB]
* RVU19A (Excluding Attachment A)
* PPRRVU19_V1213
* OPPSCAP_Jan
* 19LOCCO
* GPCI2019
Excluding:
ANES2019
For services rendered on or after April 1, 2019:
RVU19B [ZIP, 3MB]
* RVU19B (Excluding Attachment A)
* PPRRVU19_APR
* OPPSCAP_APR
* 19LOCCO
* GPCI2019
Excluding:
ANES2019
For services rendered on or after July 1, 2019:
RVU19C [ZIP, 3MB]
* RVU19C (Excluding Attachment A)
* PPRRVU19_JUL
* OPPSCAP_JUL
* 19LOCCO
* GPCI2019
Excluding:
ANES2019
For services rendered on or after October 1,
								2019:
RVU19D [ZIP, 3MB]
* RVU19D (Excluding Attachment A)
* PPRRVU19_OCT
* OPPSCAP_OCT
* 19LOCCO
* GPCI2019
Excluding:
ANES2019
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
Anesthesia Conversion Factor: $27.6859
Other Services Conversion Factor: $45.8513
Current Procedural Terminology (CPT®)
CPT 2019
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code_WC005 code)
97014 (Use G0283)
97127 (Use G0515)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1, 2019:
								RVU19A, PPRRVU19_V1213, number "6" in column S, labeled "Mult Proc" (Modifier
								51), also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction
								Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Cardiovascular
								Services Subject to MPPR
For services rendered on or after April 1, 2019:
								RVU19B, PPRRVU19_APR, number "6" in column S, labeled "Mult Proc" (Modifier
								51), also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction
								Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Cardiovascular
								Services Subject to MPPR
For services rendered on or after July 1, 2019:
								RVU19C, PPRRVU19_JUL, number "6" in column S, labeled "Mult Proc" (Modifier
								51), also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction
								Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Cardiovascular
								Services Subject to MPPR
For services rendered on or after October 1, 2019:
								RVU19D, PPRRVU19_OCT, number "6" in column S, labeled "Mult Proc" (Modifier
								51), also listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction
								Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic Cardiovascular
								Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2019:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU19A, RVU19A (PDF document)
For services rendered on or after April 1, 2019:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU19B, RVU19B (PDF document)
For services rendered on or after July 1, 2019:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU19C, RVU19C (PDF document)
For services rendered on or after October 1,
								2019:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU19D, PPRRVU19_OCT (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2019:
RVU19A, PPRRVU19_V1213, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator," also listed in CY 2019 PFS
								Final Rule Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the
								document CMS-1693-F_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after April 1, 2019:
								RVU19B, PPRRVU19_APR, number "88" in column AB, labeled, "Diagnostic Imaging
								Family Indicator," also listed in CY 2019 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after July 1, 2019:
								RVU19C, PPRRVU19_JUL, number "88" in column AB, labeled, "Diagnostic Imaging
								Family Indicator," also listed in CY 2019 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic
								Imaging Services Subject to MPPR
For services rendered on or after October 1, 2019:
								RVU19D, PPRRVU19_OCT, number "88" in column AB, labeled, "Diagnostic Imaging
								Family Indicator," also listed in CY 2019 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Diagnostic
								Imaging Services Subject to MPPR
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after January 1, 2019:
								RVU19A, PPRRVU19_V1213, number "4" in column S, labeled, "Mult Proc," also
								listed in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files
								[ZIP, 61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to
								MPPR
For services rendered on or after April 1, 2019:
								RVU19B, PPRRVU19_APR, number "4" in column S, labeled, "Mult Proc," also listed
								in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP,
								61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to
								MPPR
For services rendered on or after July 1, 2019:
								RVU19C, PPRRVU19_JUL, number "4" in column S, labeled, "Mult Proc," also listed
								in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP,
								61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to
								MPPR
For services rendered on or after October 1, 2019:
								RVU19D, PPRRVU19_OCT, number "4" in column S, labeled, "Mult Proc," also listed
								in CY 2019 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP,
								61KB], in the document CMS-1693-F_Diagnostic Imaging Services Subject to
								MPPR
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after January 1,
								2019:
RVU19A
* GPCI2019 Addendum E -- Column B ("Locality
								Number"), column C ("Locality Name"), column D ("PW GPCI"), column E ("PE
								GPCI"), and column F ("MP GPCI") for the State of California ("CA")
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2019:
RVU19B
* GPCI2019 Addendum E -- Column B ("Locality
								Number"), column C ("Locality Name"), column D ("PW GPCI"), column E ("PE
								GPCI"), and column F ("MP GPCI") for the State of California ("CA")
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2019:
RVU19C
* GPCI2019 Addendum E -- Column B ("Locality
								Number"), column C ("Locality Name"), column D ("PW GPCI"), column E ("PE
								GPCI"), and column F ("MP GPCI") for the State of California ("CA")
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2019:
RVU19D
* GPCI2019 Addendum E -- Column B ("Locality
								Number"), column C ("Locality Name"), column D ("PW GPCI"), column E ("PE
								GPCI"), and column F ("MP GPCI") for the State of California ("CA")
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after January 1,
								2019:
2019 Anesthesia Conversion Factors [ZIP, 18KB] (These
								factors have been incorporated into the conversion factors listed on section
								9789.19.1, Table A)
* Locality-Adjusted Anesthesia Conversion Factors as
								a result of the CY 2019 Final Rule, excluding column G labeled, "National Anes
								CF of 22.2730"
* Anesthesia Shares
RVU19A (County to locality index)
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2019:
2019 Anesthesia Conversion Factors [ZIP, 18KB] (These
								factors have been incorporated into the conversion factors listed on section
								9789.19.1, Table A)
* Locality-Adjusted Anesthesia Conversion Factors as
								a result of the CY 2019 Final Rule, excluding column G labeled, "National Anes
								CF of 22.2730"
* Anesthesia Shares
RVU19B (County to locality index)
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2019:
2019 Anesthesia Conversion Factors [ZIP, 18KB] (These
								factors have been incorporated into the conversion factors listed on section
								9789.19.1, Table A)
* Locality-Adjusted Anesthesia Conversion Factors as
								a result of the CY 2019 Final Rule, excluding column G labeled, "National Anes
								CF of 22.2730"
* Anesthesia Shares
RVU19C (County to locality index)
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2019:
2019 Anesthesia Conversion Factors [ZIP, 18KB] (These
								factors have been incorporated into the conversion factors listed on section
								9789.19.1, Table A)
* Locality-Adjusted Anesthesia Conversion Factors as
								a result of the CY 2019 Final Rule, excluding column G labeled, "National Anes
								CF of 22.2730"
* Anesthesia Shares
RVU19D, (County to locality index)
* 19LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Note:
Access the Anesthesia Conversion Factors File on the
								CMS website:
https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after January 1,
								2019:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
Zip Code to Carrier Locality File -- Revised
								11/14/2018 [ZIP, 4MB], Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring + 4 extension -- Revised
								11/14/2018 [ZIP, 1KB], for the State of California ("CA")
For services rendered on or after April 1, 2019:
Zip Code to Carrier Locality File -- Revised
								2/15/2019 [ZIP, 4MB], Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring +4 extension -- Revised 2/15/2019
								[ZIP, 1KB], for the State of California ("CA")
For services rendered on or after July 1, 2019:
Zip Code to Carrier Locality File -- Revised
								05/15/2019 [ZIP, 4MB], Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring +4 extension -- Revised
								05/15/2019 [ZIP, 1KB], for the State of California ("CA")
For services rendered on or after October 1,
								2019:
Zip Code to Carrier Locality File -- Revised
								08/13/2019 [ZIP, 4MB], Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring +4 extension -- Revised
								08/13/2019 [ZIP, 1KB], for the State of California ("CA")
Note:
Access the Zip Code files on the DWC website:
https://www.dir.ca.gov/dwc/OMFS9904.htm#7
CMS posts only the most recent version of the Zip
								Code files, which can be accessed on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html
Geographic Health Professional Shortage Area zip code
								data files
2019 Primary Care HPSA [ZIP, 100KB]
2019 Mental Health HPSA [ZIP, 218KB]
Access the files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By State & County)
http://hpsafind.hrsa.gov/
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
http://datawarehouse.hrsa.gov/geoHPSAAdvisor/GeographicHPSAAdvisor.aspx
Incident To Codes
For services rendered on or after January 1, 2019:
								RVU19A, PPRRVU19_V1213, number "5" in column N, labeled, "PCTC IND," (PC/TC
								Indicator)
For services rendered on or after April 1, 2019:
								RVU19B, PPRRVU19_APR, number "5" in column N, labeled, "PCTC IND," (PC/TC
								Indicator)
For services rendered on or after July 1, 2019:
								RVU19C, PPRRVU19_JUL, number "5" in column N, labeled, "PCTC IND," (PC/TC
								Indicator)
For services rendered on or after October 1, 2019:
								RVU19D, PPRRVU19_OCT, number "5" in column N, labeled, "PCTC IND," (PC/TC
								Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after January 1, 2019,
								use:
Medi-Cal Rates file -- Updated 12/15/2018
For services rendered on or after January 15, 2019,
								use:
Medi-Cal Rates file -- Updated 1/15/2019
For services rendered on or after February 15, 2019,
								use:
Medi-Cal Rates file -- Updated 2/15/2019
For services rendered on or after March 15, 2019,
								use:
Medi-Cal Rates file -- Updated 3/15/2019
For services rendered on or after April 15, 2019,
								use:
Medi-Cal Rates file -- Updated 4/15/2019
For services rendered on or after May 15, 2019,
								use:
Medi-Cal Rates file -- Updated 5/15/2019
For services rendered on or after June 15, 2019,
								use:
Medi-Cal Rates file -- Updated 6/15/2019
For services rendered on or after July 15, 2019,
								use:
Medi-Cal Rates file -- Updated 7/15/2019
For services rendered on or after August 15, 2019,
								use:
Medi-Cal Rates file -- Updated 8/15/2019
For services rendered on or after September 15, 2019,
								use:
Medi-Cal Rates file -- Updated 9/15/2019
For services rendered on or after October 15, 2019,
								use:
Medi-Cal Rates file -- Updated 10/15/2019
For services rendered on or after November 15, 2019,
								use:
Medi-Cal Rates file -- Updated 11/15/2019
For services rendered on or after December 15, 2019,
								use: Medi-Cal Rates file -- Updated 12/15/2019
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2019:
RVU19A, PPRRVU19_V1213, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2019 PFS Final Rule
								Multiple Procedure Payment Reduction Files [ZIP, 61KB], in the document
								CMS-1693-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2019:
RVU19B, PPRRVU19_APR, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2019 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 61KB], in the document
								CMS-1693-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2019:
RVU19C, PPRRVU19_JUL, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2019 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 61KB], in the document
								CMS-1693-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2019:
RVU19D, PPRRVU19_OCT, number "7" in column S, labeled
								"Mult Proc" (Modifier 51). Also listed in CY 2019 PFS Final Rule Multiple
								Procedure Payment Reduction Files [ZIP, 61KB], in the document
								CMS-1693-F_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2019:
RVU19A, PPRRVU19_V1213, number "5" in column S,
								labeled "Mult Proc." Also listed in CY 2019 PFS Final Rule Multiple Procedure
								Payment Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Separately
								Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2019:
RVU19B, PPRRVU19_APR, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2019 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2019:
RVU19C, PPRRVU19_JUL, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2019 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2019:
RVU19D, PPRRVU19_OCT, number "5" in column S, labeled
								"Mult Proc." Also listed in CY 2019 PFS Final Rule Multiple Procedure Payment
								Reduction Files [ZIP, 61KB], in the document CMS-1693-F_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2019 PFS Final Rule Physician Time [ZIP,
								244KB]
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
(g) Services Rendered On or After January 1,
					 2020. Documents listed in the following table are incorporated by reference and
					 will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After January
								1, 2020 & Mid-year Updates
Adjustment Factors -- Services Other than
								Anesthesia
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factors listed below)
2020 RVU budget neutrality adjustment factor:
								1.0014
2020 Annual increase in the MEI: 1.019
Adjustment Factors -- Anesthesia
For anesthesia services:
(These factors have been incorporated into the
								conversion factors listed on Table A 2020, RVU20A, updated 01-22-2020)
2020 RVU budget neutrality adjustment factor:
								1.0014
2020 Anesthesia practice expense and malpractice
								adjustment factor: 0.9954
2020 Annual increase in the MEI: 1.019
Anesthesia Base Units by CPT Code
File name:
cms1676f_cy_2018_anesthesia_base_units.xlsx
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $12.89
WC003 -- $41.84 for first page
$25.73 each additional page. Maximum of six pages
								absent mutual agreement ($170.49)
WC004 -- $41.84 for first page
$25.73 each additional page. Maximum of seven pages
								absent mutual agreement ($196.22)
WC005 -- $41.84 for first page
$25.73 each additional page. Maximum of six pages
								absent mutual agreement ($170.49)
WC007 -- $41.84 for first page
$25.73 each additional page. Maximum of six pages
								absent mutual agreement ($170.49)
WC008 -- $11.10 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $11.10 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.54 per x-ray
WC011 -- $11.10 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after January 1, 2020,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								01-01-2020 (ZIP)," excluding all codes listed with Practitioner Services MUE
								Value of "0" (zero).
For services rendered on or after April 1, 2020,
								use:
"Practitioner Services MUE Table -- Replacement
								Effective 04-01-2020 (ZIP)," excluding all codes listed with Practitioner
								Services MUE Value of "0" (zero).
For services rendered on or after July 1, 2020,
								use:
"Practitioner Services MUE Table --
								Effective-07-01-2020 posted June 1, 2020 (ZIP)," excluding all codes listed
								with Practitioner Services MUE Value of "0" (zero).
For services rendered on or after October 1, 2020,
								use:
"Practitioner Services MUE Table --
								Effective-10-01-2020 posted September 1, 2020 (ZIP)," excluding all codes
								listed with Practitioner Services MUE Value of "0" (zero).
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
"NCCI Policy Manual for Medicare Services --
								Effective January 1, 2020 (ZIP)"
National Correct Coding Initiative Policy Manual for
								Medicare Services
CCI Edits:
Practitioner Procedure to Procedure (PTP) Edits
For services rendered on or after January 1,
								2020:
Practitioner PTP Edits v26.0 effective January 1,
								2020
(532,510 records) 0001M/36591 -- 26992/G0471
Practitioner PTP Edits v26.0 effective January 1,
								2020
(529,304 records) 27000/01995 -- 37799/96523
Practitioner PTP Edits v26.0 effective January 1,
								2020
(503,060 records) 38100/0213T -- 61888/G0471
Practitioner PTP Edits v26.0 effective January 1,
								2020
(562,155 records): 62000/0213T -- R0075/R0070
For services rendered on or after March 13,
								2020:
Practitioner PTP Edits v260r2 effective January 1,
								2020
(532,511 records) 0001M/36591 -- 25999/96523
Practitioner PTP Edits v260r2 effective January 1,
								2020
(529,304 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v260r2 effective January 1,
								2020
(503,060 records) 37140/0213T -- 59899/96523
Practitioner PTP Edits v260r2 effective January 1,
								2020
(561,874 records) 60000/0213T -- R0075/R0070
For services rendered on or after April 1, 2020:
Practitioner PTP Edits v261r1 effective April 1,
								2020
(532,940 records) 0001M/36591 -- 25999/96523
Practitioner PTP Edits v261r1 effective April 1,
								2020
(529,534 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v261r1 effective April 1,
								2020
(503,072 records) 37140/0213T -- 59899/96523
Practitioner PTP Edits v261r1 effective April 1,
								2020
(562,285 records): 60000/0213T -- R0075/R0070
For services rendered on or after July 1, 2020:
Practitioner PTP Edits v262r0 effective July 1,
								2020
(532,964 records) 0001M/36591 -- 25999/96523
Practitioner PTP Edits v262r0 effective July 1,
								2020
(529,569 records) 26010/01810 -- 36909/J2001
Practitioner PTP Edits v262r0 effective July 1,
								2020
(503,072 records) 37140/0213T -- 59899/96523
Practitioner PTP Edits v262r0 effective July 1,
								2020
(562,291 records): 60000/0213T -- R0075/R0070
For services rendered on or after October 1,
								2020:
Practitioner PTP Edits v263r0 effective October 1,
								2020
(603,809 records) 0001M/36591 -- 25999/96523 (posted
								09/01/2020)
Practitioner PTP Edits v263r0 effective October 1,
								2020
(599,847 records) 26010/01810 -- 36909/J2001 (posted
								09/01/2020)
Practitioner PTP Edits v263r0 effective October 1,
								2020
(580,791 records) 37140/0213T -- 60699/96523 (posted
								09/01/2020)
Practitioner PTP Edits v263r0 effective October 1,
								2020
(634,723 records): 60000/0213T -- R0075/R0070 (posted
								09/01/2020)
Access the Practitioner PTP Edits on the CMS website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file on the CMS website
								covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020) (ZIP)
* RVU20A (Excluding Attachment A)
* PPRRVU20_Jan
* OPPSCAP_Jan
* 20LOCCO
* GPCI2020
Excluding:
ANES2020
For services rendered on or after March 1, 2020, for
								CPT codes 99441, 99442, 99443:
RVU20B (Updated 05/01/2020) (ZIP)
* RVU20B-508 (Excluding Attachment A)
* PPRRVU20_APR
* OPPSCAP_APR
* 20LOCCO
* GPCI2020
Excluding:
ANES2020
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP)
* RVU20B-508 (Excluding Attachment A)
* PPRRVU20_APR
* OPPSCAP_APR
* 20LOCCO
* GPCI2020
Excluding:
ANES2020
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP)
* RVU20C (Excluding Attachment A)
* PPRRVU20_V0618
* OPPSCAP_JUL
* 20LOCCO.
* GPCI2020
Excluding:
ANES2020
For services rendered on or after October 1,
								2020
RVU20D (ZIP)
* RVU20D (Excluding Attachment A)
* PPRRVU20_OCT
* OPPSCAP_OCT
* 20LOCCO
* GPCI2020
Excluding:
ANES2020
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factor
Anesthesia Conversion Factor: $28.12 [See Table A
								2020, RVU20A, updated 01-22-2020, Effective January 1, 2020 for GPCI-Adjusted
								Conversion Factors by locality]
Other Services Conversion Factor: $46.79
Current Procedural Terminology (CPT®)
CPT 2020
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number "6"
								in column S, labeled "Mult Proc" (Modifier 51), also listed in CY 2020 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Cardiovascular Services Subject to MPPR.
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2020 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1715-F_CY2020_Diagnostic Cardiovascular Services Subject to
								MPPR.
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP)
PPRRVU20_V0618, number "6" in column S, labeled "Mult
								Proc" (Modifier 51), also listed in CY 2020 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1715-F_CY2020_Diagnostic
								Cardiovascular Services Subject to MPPR.
For services rendered on or after October 1, 2020:
								RVU20D (ZIP)
PPRRVU20_OCT, number "6" in column S, labeled "Mult
								Proc" (Modifier 51), also listed in CY 2020 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1715-F_CY2020_Diagnostic
								Cardiovascular Services Subject to MPPR.
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2020:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU20A (Updated 01/31/2020), RVU20A (PDF
								document)
For services rendered on or after April 1, 2020:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU20B (Updated 05/01/2020) (ZIP), RVU20B-508 (PDF
								document)
For services rendered on or after July 1, 2020:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU20C (Updated 06/19/2020) (ZIP), RVU20C (PDF
								document)
For services rendered on or after October 1,
								2020:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU20D (ZIP), RVU20D (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number
								"88" in column AB, labeled, "Diagnostic Imaging Family Indicator," also listed
								in CY 2020 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in
								the document CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator," also
								listed in CY 2020 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to
								MPPR
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP)
PPRRVU20_V0618, number "88" in column AB, labeled,
								"Diagnostic Imaging Family Indicator," also listed in CY 2020 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR
For services rendered on or after October 1,
								2020:
RVU20D (ZIP)
PPRRVU20_OCT, number "88" in column AB, labeled,
								"Diagnostic Imaging Family Indicator," also listed in CY 2020 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number "4"
								in column S, labeled, "Mult Proc," also listed in CY 2020 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "4" in column S, labeled, "Mult Proc," also listed in CY 2020 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP), PPRRVU20_V0618,
								number "4" in column S, labeled, "Mult Proc," also listed in CY 2020 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after October 1,
								2020:
RVU20D (ZIP), PPRRVU20_OCT, number "4" in column S,
								labeled, "Mult Proc," also listed in CY 2020 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1715-F_CY2020_Diagnostic
								Imaging Services Subject to MPPR.
DWC Pharmaceutical Fee Schedule
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020)
* GPCI2020 -- Column B ("Locality Number"), column C
								("Locality Name"), column D ("2020 PW GPCI"), column E ("2020 PE GPCI"), and
								column F ("2020 MP GPCI") for the State of California
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP)
* GPCI2020 -- Column B ("Locality Number"), column C
								("Locality Name"), column D ("2020 PW GPCI"), column E ("2020 PE GPCI"), and
								column F ("2020 MP GPCI") for the State of California
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP)
* GPCI2020 -- Column B ("Locality Number"), column C
								("Locality Name"), column D ("2020 PW GPCI"), column E ("2020 PE GPCI"), and
								column F ("2020 MP GPCI") for the State of California
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2020:
RVU20D (ZIP)
* GPCI2020 -- Column B ("Locality Number"), column C
								("Locality Name"), column D ("2020 PW GPCI"), column E ("2020 PE GPCI"), and
								column F ("2020 MP GPCI") for the State of California
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after January 1,
								2020:
Section
								9789.19.1, Table A 2020 RVU20A,
								Updated 01-22-2020, Effective January 1, 2020 incorporates the Medicare
								locality GPCIs into the updated locality-adjusted Anesthesia conversion
								factors.
Medicare data utilized to derive the conversion
								factors on Table A Effective January 1, 2020 is as follows.
2020 Anesthesia Conversion Factors [ZIP]
(CMS-1715-F_CY2020_ANES_locality
								adjusted_CF_withWorkFloor_09JAN2020)
* Locality-specific 2020 Work GPCI, 2020 PE GPCI,
								2020 MP GPCI for California as a result of the CY 2020 Final Rule, and January
								9, 2020 correction to Addendum E, columns B, C, D, E, and F, excluding columns
								A and G labeled "Contractor" and "National Anes CF of 22.2016" [excel sheet:
								Locality Adjusted CFs]
* Anesthesia Shares [excel sheet: Anesthesia
								Shares]
For services rendered on or after April 1, 2020:
Section
								9789.19.1, Table A 2020 RVU20A,
								Updated 01-22-2020, remains effective for services rendered on or after April
								1, 2020.
For services rendered on or after July 1, 2020:
Section
								9789.19.1, Table A 2020 RVU20A,
								Updated 01-22-2020, remains effective for services rendered on or after July 1,
								2020.
Locality for anesthesia services determined by
								Medicare county to locality index.
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020) (County to locality
								index)
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP) (County to locality
								index)
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP) (County to locality
								index)
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2020:
RVU20D (ZIP) (County to locality index)
* 20LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Note:
Access the Anesthesia Conversion Factors File on the
								CMS website:
https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after January 1,
								2020:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
Zip Code to Carrier Locality File -- Revised
								11/19/2019 (ZIP), Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring 4 extension -- Revised 11/19/2019
								(ZIP), for the State of California ("CA")
For services rendered on or after April 1, 2020:
Zip Code to Carrier Locality File -- Revised
								02/19/2020 (ZIP), Column A ("STATE"), column B ("ZIP CODE") and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring 4 extension -- Revised 02/14/2020
								(ZIP), for the State of California ("CA")
For services rendered on or after July 1, 2020:
Zip Code to Carrier Locality File -- Revised
								05/13/2020 (ZIP), Column A ("STATE"), column B ("ZIP CODE") and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring 4 extension -- Revised 05/13/2020
								(ZIP), for the State of California ("CA")
For services rendered on or after October 1,
								2020:
Zip Code to Carrier Locality File -- Revised
								08/13/2020 (ZIP), Column A ("STATE"), column B ("ZIP CODE") and column D
								("LOCALITY") for the State of California ("CA")
Zip Codes requiring 4 extension -- Revised 08/13/2020
								(ZIP), for the State of California ("CA"
Note:
Access the Zip Code files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html
Geographic Health Professional Shortage Area zip code
								data files
2020 Primary Care HPSA (ZIP)
2020 Mental Health HPSA (ZIP)
Access the HPSA files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index
Health Resources and Services Administration:
								Geographic HPSA shortage area query
https://data.hrsa.gov/tools/shortage-area/hpsa-find
(By State & County)
Health Resources and Services Administration:
								Geographic HPSA shortage area query
https://data.hrsa.gov/tools/medicare/physician-bonus
(By Address)
Incident To Codes
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number "5"
								in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP), PPRRVU20_V0618,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after October 1,
								2020:
RVU20D (ZIP)
PPRRVU20_OCT, number "5" in column N, labeled, "PCTC
								IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after January 1, 2020,
								use:
Medi-Cal Rates file -- Updated 12/15/2019
For services rendered on or after January 15, 2020,
								use:
Medi-Cal Rates file -- Updated 1/15/2020
For services rendered on or after February 15, 2020,
								use:
Medi-Cal Rates file -- Updated 2/15/2020
For services rendered on or after March 15, 2020,
								use:
Medi-Cal Rates file -- Updated 3/15/2020
For services rendered on or after April 15, 2020,
								use:
Medi-Cal Rates file -- Updated 4/15/2020
For services rendered on or after May 15, 2020,
								use:
Medi-Cal Rates file -- Updated 5/15/2020
For services rendered on or after June 15, 2020,
								use:
Medi-Cal Rates file -- Updated 6/15/2020
For services rendered on or after July 15, 2020,
								use:
Medi-Cal Rates file -- Updated 7/15/2020
For services rendered on or after August 15, 2020,
								use:
Medi-Cal Rates file -- Updated 8/15/2020
For services rendered on or after September 15, 2020,
								use:
Medi-Cal Rates file -- Updated 9/15/2020
For services rendered on or after October 15, 2020,
								use:
Medi-Cal Rates file -- Updated 10/15/2020
For services rendered on or after November 15, 2020,
								use:
Medi-Cal Rates file -- Updated 11/15/2020
For services rendered on or after December 15, 2020,
								use:
Medi-Cal Rates file -- Updated 12/15/2020
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number "7"
								in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY 2020 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP) in the document
								CMS-1715-F_CY2020_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2020 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP) in the
								document CMS-1715-F_CY2020_Diagnostic Ophthalmology Services Subject to
								MPPR
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP), PPRRVU20_V0618,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2020 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP) in the
								document CMS-1715-F_CY2020_Diagnostic Ophthalmology Services Subject to
								MPPR
For services rendered on or after October 1,
								2020:
RVU20D (ZIP)
PPRRVU20_OCT, number "7" in column S, labeled "Mult
								Proc" (Modifier 51). Also listed in CY 2020 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP) in the document CMS-1715-F_CY2020_Diagnostic
								Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2020:
RVU20A (Updated 01/31/2020), PPRRVU20_Jan, number "5"
								in column S, labeled "Mult Proc." Also listed in CY 2020 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2020:
RVU20B (Updated 05/01/2020) (ZIP), PPRRVU20_APR,
								number "5" in column S, labeled "Mult Proc." Also listed in CY 2020 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2020:
RVU20C (Updated 06/19/2020) (ZIP), PPRRVU20_V0618,
								number "5" in column S, labeled "Mult Proc." Also listed in CY 2020 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1715-F_CY2020_Separately Payable Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2020:
RVU20D (ZIP)
PPRRVU20_OCT, number "5" in column S, labeled "Mult
								Proc." Also listed in CY 2020 PFS Final Rule Multiple Procedure Payment
								Reduction Files (ZIP), in the document CMS-1715-F_CY2020_Separately Payable
								Therapy Services Subject to MPPR
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2020 PFS Final Rule Physician Time (Zip)
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
Telehealth -- Services Accessible Through Telehealth
								(using audio and video telecommunication method and audio only
								telecommunication method) During the COVID-19 Public Health Emergency
For services on or after March 1, 2020:
CMS -- "Telehealth Services for PHE for the COVID-19
								pandemic effective March 1 2020-updated April 30 2020"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video. The list is adopted retroactively for services rendered
								on or after March 1, 2020.
In accord with CPT 2020, append modifier 95 to
								procedure code when delivered via telehealth.
For services on or after October 14, 2020:
CMS -- "Telehealth Services for PHE for the COVID-19
								pandemic effective March 1 2020-updated October 14, 2020"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video. The list is adopted retroactively for services rendered
								on or after March 1, 2020, except that the following codes identified on the
								excel spreadsheet as "Added 10/14/20" are effective for services rendered on or
								after October 14, 2020:
CPT code 93797
CPT code 93798
CPT code 93750
CPT code 95970
CPT code 95971
CPT code 95972
CPT code 95983
CPT code 95984
HCPCS code G0422
HCPCS code G0423
HCPCS code G0424
In accord with CPT 2020, append modifier 95 to
								procedure code when delivered via telehealth.
The 1995 Documentation Guidelines for Evaluation
								& Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/95Docguidelines.pdf
The 1997 Documentation Guidelines for Evaluation and
								Management Services
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
(h) Services Rendered On or After March 1,
					 2021. Documents listed in the following table are incorporated by reference and
					 will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After March
								1, 2021 & Mid-year Updates
Adjustment Factors -- Services Other than
								Anesthesia
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factors listed below)
2021 RVU budget neutrality adjustment factor: -6.81%
								(.9319)
2021 Annual increase in the MEI: 1.4% (1.014)
Consolidated Appropriations Act, 2021, increase of
								3.75% (1.0375)
Adjustment Factors -- Anesthesia
For anesthesia services:
(These factors have been incorporated into the
								conversion factors listed on Table A 2021, RVU21A (Updated 01/05/2021)
								Effective 03.01.2021)
2021 RVU budget neutrality adjustment factor: -6.81%
								(.9319)
2021 Anesthesia practice expense and malpractice
								adjustment factor: 0.44% (1.0044)
2021 Annual increase in the MEI: 1.4% (1.014)
Consolidated Appropriations Act, 2021, increase of
								3.75% (1.0375)
Anesthesia Base Units by CPT Code
File name:
cms1676f_cy_2018_anesthesia_base_units.xlsx
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $13.70
WC003 -- $42.43 for first page
$26.09 each additional page. Maximum of six pages
								absent mutual agreement ($172.88)
WC004 -- $42.43 for first page
$26.09 each additional page. Maximum of seven pages
								absent mutual agreement ($198.97)
WC005 -- $42.43 for first page
$26.09 each additional page. Maximum of six pages
								absent mutual agreement ($172.88)
WC007 -- $42.43 for first page
$26.09 each additional page. Maximum of six pages
								absent mutual agreement ($172.88)
WC008 -- $12.25 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC009 -- $12.25 for up to the first 15 pages. $0.25
								for each additional page after the first 15 pages.
WC010 -- $5.62 per x-ray
WC011 -- $12.25 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CCI Edits:
For services rendered on or after March 1, 2021,
								use:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								01-01-2021 Replacement-Posted December 14, 2020 (ZIP)," in the document "MCR
								MUE PractitionerServices Eff 01-01-2021 Replacement", excluding all codes
								listed with Practitioner Services MUE Value of "0" (zero).
For services rendered on or after April 1, 2021,
								use:
"Practitioner Services MUE Table --
								Effective-04-01-2021- Posted March 1, 2021 (ZIP)," excluding all codes listed
								with Practitioner Services MUE Value of "0" (zero).
For services rendered on or after July 1, 2021,
								use:
"Practitioner Services MUE Table --
								Effective-07-01-2021- Posted June 1, 2021 (ZIP)," excluding all codes listed
								with Practitioner Services MUE Value of "0" (zero).
For services rendered on or after October 1, 2021,
								use:
"Practitioner Services MUE Table --
								Effective-10-01-2021 Posted September 3, 2021 (ZIP)," excluding all codes
								listed with Practitioner Services MUE Value of "0" (zero).
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
CCI Edits:
NCCI Policy Manual for Medicare Services -- Revision
								Date January 1, 2021
National Correct Coding Initiative Policy Manual for
								Medicare Services
Access on the CMS NCCI Policy Manual webpage
CCI Edits:
For services rendered on or after March 1, 2021:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v270r0 effective January 1,
								2021
(619,579 records) 0001M/36591 -- 25999/96523 (posted
								12/01/2020)
Practitioner PTP Edits v270r0 effective January 1,
								2021
(605,350 records) 26010/01810 -- 36909/J2001 (posted
								12/01/2020)
Practitioner PTP Edits v270r0 effective January 1,
								2021
(584,660 records) 37140/0213T -- 60699/96523 (posted
								12/01/2020)
Practitioner PTP Edits v270r0 effective January 1,
								2021
(644,531 records): 60000/0213T -- R0075/R0070 (posted
								12/01/2020)
For services rendered on or after April 1, 2021:
Practitioner PTP Edits v271r0 effective April 1,
								2021
(620,263 records) 0001M/36591 -- 25999/96523 (posted
								03/01/2021)
Practitioner PTP Edits v271r0 effective April 1,
								2021
(605,577 records) 26010/01810 -- 36909/J2001 (posted
								03/01/2021)
Practitioner PTP Edits v271r0 effective April 1,
								2021
(584,943 records) 37140/0213T -- 60699/96523 (posted
								03/01/2021)
Practitioner PTP Edits v271r0 effective April 1,
								2021
(644,832 records): 61000/0213T -- R0075/R0070 (posted
								03/01/2021))
For services rendered on or after July 1, 2021:
Practitioner PTP Edits v272r0 effective July 1,
								2021
(620,389 records) 0001M/36591 -- 25999/96523 (posted
								06/01/2021)
Practitioner PTP Edits v272r0 effective July 1,
								2021
(605,582 records) 26010/01810 -- 36909/J2001 (posted
								06/01/2021)
Practitioner PTP Edits v272r0 effective July 1,
								2021
(584,943 records) 37140/0213T -- 60699/96523 (posted
								06/01/2021)
Practitioner PTP Edits v272r0 effective July 1,
								2021
(644,928 records): 61000/0213T -- U0003/U0004 (posted
								06/01/2021)
For services rendered on or after October 1,
								2021:
Practitioner PTP Edits v273r2 effective October 1,
								2021
(620,422 records) 0001M/36591 -- 25999/96523 (posted
								10/05/2021)
Practitioner PTP Edits v273r2 effective October 1,
								2021
(605,586 records) 26010/01810 -- 36909/J2001 (posted
								10/05/2021)
Practitioner PTP Edits v273r2 effective October 1,
								2021
(584,947 records) 37140/0213T -- 60699/96523 (posted
								10/05/2021)
Practitioner PTP Edits v273r2 effective October 1,
								2021
(645,310 records): 61000/0213T -- U0003/U0004 (posted
								10/05/2021)
Access the Practitioner PTP Edits on the CMS website:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file on the CMS website
								covers all time periods.
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP)
* RVU21A (Excluding Attachment A)
* PPRRVU21_Jan
* OPPSCAP_Jan
* 21LOCCO
* GPCI2021
Excluding:
ANES2021
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP)
* RVU21B (Excluding Attachment A)
* PPRRVU21_APR
* OPPSCAP_APR
* 21LOCCO
* GPCI2021
Excluding:
ANES2021
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP)
* RVU21C (Excluding Attachment A)
* PPRRVU21_JUL
* OPPSCAP_JUL
* 21LOCCO
* GPCI2021
Excluding:
ANES2021
For services rendered on or after October 1,
								2021:
RVU21D (ZIP)
* RVU21D-508 (Excluding Attachment A)
* PPRRVU21_OCT
* OPPSCAP_OCT
* 21LOCCO
* GPCI2021
Excluding:
ANES2021
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Conversion Factors adjusted for MEI and Relative
								Value Scale adjustment factors and Consolidated Appropriations Act, 2021
								increase
Anesthesia Conversion Factor: $27.69
[See Section
								9789.19.1 Table A 2021, RVU21A
								updated 01.05.2021, Effective for services on or after March 1, 2021 for
								GPCI-Adjusted Conversion Factors by locality]
Other Services Conversion Factor: $45.87
Current Procedural Terminology (CPT®)
CPT 2021
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99417 (See §
															9789.12.11. Use code G2212)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2021 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after March 1, 2021:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU21A (Updated 01/05/2021) (ZIP), RVU21A (PDF
								document)
For services rendered on or after April 1, 2021:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU21B (Updated 03/02/2021) (ZIP), RVU21B (PDF
								document)
For services rendered on or after July 1, 2021:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU21C -- Updated 06/30/2021 (ZIP), RVU21C (PDF
								document)
For services rendered on or after October 1,
								2021:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU21D (ZIP), RVU21D-508 (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2021 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1734-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2021 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1734-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2021 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1734-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2021 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Imaging Services Subject to MPPR.
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2021 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2021 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2021 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2021 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1734-F_Diagnostic Imaging
								Services Subject to MPPR.
DWC Pharmaceutical Fee Schedule
Web address:
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP)
* GPCI2021 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2021 PW GPCI (without 1.0 Floor)"), column F
								("2021 PE GPCI"), and column G ("2021 MP GPCI") for the State of
								California
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP),
* GPCI2021 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2021 PW GPCI (without 1.0 Floor)"), column F
								("2021 PE GPCI"), and column G ("2021 MP GPCI") for the State of
								California
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP)
* GPCI2021 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2021 PW GPCI (without 1.0 Floor)"), column F
								("2021 PE GPCI"), and column G ("2021 MP GPCI") for the State of
								California
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after October 1,
								2021:
RVU21D (ZIP)
* GPCI2021 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2021 PW GPCI (without 1.0 Floor)"), column F
								("2021 PE GPCI"), and column G ("2021 MP GPCI") for the State of
								California
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
Access the Relative Value File (ZIP) on the CMS
								website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after March 1, 2021:
Section
								9789.19.1, "Table A 2021 RVU21A
								(Updated 01-05-2021), Effective March 1, 2021" incorporates the Medicare
								locality GPCIs and anesthesia shares into the updated locality-adjusted
								Anesthesia conversion factors.
Locality determined by Medicare county to locality
								index.
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP) (County to locality
								index)
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2021:
Section
								9789.19.1, "Table A 2021 RVU21A
								(Updated 01-05-2021), Effective March 1, 2021" remains effective for services
								rendered on or after April 1, 2021.
Locality determined by Medicare county to locality
								index.
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP) (County to locality
								index)
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP) (County to
								locality index)
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2021:
RVU21D (ZIP) (County to locality index)
* 21LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after March 1, 2021:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
"Zip Code to Carrier Locality File -- Revised
								11/13/2020" (ZIP), in the document "ZIP5_JAN2021": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								11/13/2020" (ZIP) in the document: "ZIP5 requiring +4ext_dec2020_jan2021", for
								the State of California ("CA")
For services rendered on or after April 1, 2021:
"Zip Code to Carrier Locality File -- Revised
								02/18/2021 (ZIP)", in the document "ZIP5 APR2021": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								02/17/2021 (ZIP)" in the document: "ZIP5_requring +4ext_apr2021.txt", for the
								State of California ("CA")
For services rendered on or after July 1, 2021:
"Zip Code to Carrier Locality File -- Revised
								06/07/2021 (ZIP)", in the document "ZIP5 JUL2021": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								05/14/2021 (ZIP)" in the document: "ZIP5 requring +4ext_jul2021", for the State
								of California ("CA")
For services rendered on or after October 1,
								2021:
"Zip Code to Carrier Locality File -- Revised
								08/13/2021 (ZIP)", in the document "ZIP5 OCT2021": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								05/14/2021 (ZIP)" in the document: "ZIP5_requring +4ext_jul2021", for the State
								of California ("CA")
Note:
Access the Zip Code files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html
Geographic Health Professional Shortage Area zip code
								data files
2021 Primary Care HPSA (ZIP)
2021 Mental Health HPSA (ZIP)
Access the HPSA files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index
Health Resources and Services Administration:
								Geographic HPSA shortage area query
Web address:
https://data.hrsa.gov/tools/shortage-area/hpsa-find
(By State & County)
Health Resources and Services Administration:
								Geographic HPSA shortage area query
Web address:
https://data.hrsa.gov/tools/medicare/physician-bonus
(By Address)
Incident To Codes
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after March 1, 2021,
								use:
Medi-Cal Rates file -- Updated 2/16/2021
For services rendered on or after March 15, 2021,
								use:
Medi-Cal Rates file -- Updated 3/15/2021
For services rendered on or after April 15, 2021,
								use:
Medi-Cal Rates file -- Updated 4/15/2021
For services rendered on or after May 15, 2021,
								use:
Medi-Cal Rates file -- Updated 5/15/2021
For services rendered on or after June 15, 2021,
								use:
Medi-Cal Rates file -- Updated 6/15/2021
For services rendered on or after July 15, 2021,
								use:
Medi-Cal Rates file -- Updated 7/15/2021
For services rendered on or after August 15, 2021,
								use:
Medi-Cal Rates file -- Updated 8/15/2021
For services rendered on or after September 15, 2021,
								use:
Medi-Cal Rates file -- Updated 9/15/2021
For services rendered on or after October 15, 2021,
								use:
Medi-Cal Rates file -- Updated 10/15/2021
For services rendered on or after November 15, 2021,
								use:
Medi-Cal Rates file -- Updated 11/15/2021
For services rendered on or after December 15, 2021,
								use:
Medi-Cal Rates file -- Updated 12/15/2021
Copies of the Medi-Cal Rates files (without CPT
								descriptors) are posted on the DWC website:
http://www.dir.ca.gov/dwc/OMFS9904.htm
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2021 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after March 1, 2021:
RVU21A (Updated 01/05/2021) (ZIP), PPRRVU21_Jan,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2021:
RVU21B (Updated 03/02/2021) (ZIP), PPRRVU21_APR,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2021:
RVU21C -- Updated 06/30/2021 (ZIP), PPRRVU21_JUL,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2021 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1734-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2021:
RVU21D (ZIP), PPRRVU21_OCT, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2021 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1734-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2021 PFS Final Rule Physician Time (Zip)
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
Telehealth -- Services Accessible Through Telehealth
								(using audio and video telecommunication method and audio only
								telecommunication method) During the COVID-19 Public Health Emergency
For services rendered on or after March 1, 2021:
CY 2021 PFS Final Rule List of Medicare Telehealth
								Services (updated 12/21/2020) (ZIP)
For services rendered on or after April 1, 2021:
List of Telehealth Services for Calendar Year 2021
								(ZIP) -- Updated 04/07/2021 in the document "List of Telehealth Services for
								Calendar Year UPDATED 033021_A"
For services rendered on or after August 1,
								2021:
List of Telehealth Services for Calendar Year 2021
								(ZIP) -- Updated 07/19/2021 in the document "List of Telehealth Services for
								Calendar Year 2021 UPDATED 10May2021"
For services rendered on or after October 1,
								2021:
List of Telehealth Services for Calendar Year 2021
								(ZIP) -- Updated 08/17/2021 in the document "List of Telehealth Services for
								Calendar Year 2021 UPDATED 12August2021"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2021, append modifier 95 to
								procedure code when delivered via telehealth.
(i) Services Rendered On or After January 1,
					 2022. Documents listed in the following table are incorporated by reference and
					 will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After January
								1, 2022 & Mid-year Updates
Adjustment Factors -- Services Other than
								Anesthesia
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factor listed below)
2022 RVU budget neutrality adjustment factor: -0.10%
								(0.9990)
2022 Annual increase in the MEI: 2.1% (1.021)
Protecting Medicare and American Farmers from
								Sequester Cuts Act, Public
								Law 117-71 increase of 3% for CY 2022 (1.03)
Adjustment Factors -- Anesthesia
For anesthesia services:
(These factors have been incorporated into the
								conversion factors listed on section
								9789.19.1 Table A 2022)
2022 RVU budget neutrality adjustment factor: -0.10%
								(0.9990)
2022 Anesthesia practice expense and malpractice
								adjustment factor: 0.84% (1.0084)
2022 Annual increase in the MEI: 2.1% (1.021)
Protecting Medicare and American Farmers from
								Sequester Cuts Act, Public
								Law 117-71 increase of 3% for CY 2022 (1.03)
Anesthesia Base Units by CPT Code
File name: CY_2022_Anesthesia_Base_Units_110921
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $13.99
WC003 -- $43.32 for first page
$26.64 each additional page. Maximum of six pages
								absent mutual agreement ($176.52)
WC004 -- $43.32 for first page
$26.64 each additional page. Maximum of seven pages
								absent mutual agreement ($203.16)
WC005 -- $43.32 for first page
$26.64 each additional page. Maximum of six pages
								absent mutual agreement ($176.52)
WC007 -- $43.32 for first page
$26.64 each additional page. Maximum of six pages
								absent mutual agreement ($176.52)
WC008 -- $12.51 for up to the first 15 pages. $0.26
								for each additional page after the first 15 pages.
WC009 -- $12.51 for up to the first 15 pages. $0.26
								for each additional page after the first 15 pages.
WC010 -- $5.74 per x-ray
WC011 -- $12.51 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after January 1,
								2022:
RVU22A (ZIP)
* RVU22A (Excluding Attachment A)
* PPRRVU22_Jan
* OPPSCAP_Jan
* 22LOCCO
* GPCI2022
Excluding:
ANES2022
For services rendered on or after April 1, 2022:
RVU22B (ZIP)
* RVU22B (Excluding Attachment A)
* PPRRVU22_APR
* OPPSCAP_APR
* 22LOCCO
* GPCI2022
Excluding:
ANES2022
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP)
* RVU22C (Excluding Attachment A)
* PPRRVU22_JUL
* OPPSCAP_JUL
* 22LOCCO
* GPCI2022
Excluding:
ANES2022
For services rendered on or after October 1,
								2022:
RVU22D (ZIP)
* RVU22D (Excluding Attachment A)
* PPRRVU22_OCT
* OPPSCAP_OCT
* 22LOCCO
* GPCI2022
Excluding:
ANES2022
Access the Relative Value File on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Conversion Factors adjusted for MEI, Relative Value
								Scale adjustment factors, and application of Protecting Medicare and American
								Farmers From Sequester Cuts Act increase of 3% for CY 2022
Anesthesia Conversion Factor: $28.28
[See Section
								9789.19.1 Table A 2022, Effective
								for services on or after January 1, 2022 for GPCI-Adjusted Conversion Factors
								by locality]
Other Services Conversion Factor: $46.45
Current Procedural Terminology (CPT®)
CPT 2022
https://commerce.ama-assn.org/store/
Current Procedural Terminology
Do not use CPT codes:
CPT codes that shall not be used
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99241 through 99245 (see §
															9789.12.12)
99251 through 99255 (see §
															9789.12.12)
99417 (See §
															9789.12.11. Use code G2212)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_Jan, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2022 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1751-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after January 1,
								2022:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU22A (ZIP), RVU22A (PDF document)
For services rendered on or after April 1, 2022:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU22B (ZIP), RVU22B (PDF document)
For services rendered on or after July 1, 2022:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU22C -- Updated 06/17/2022 (ZIP), RVU22C (PDF
								document)
For services rendered on or after October 1,
								2022:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU22D (ZIP), RVU22D (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_Jan, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2022 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2022 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2022 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1751-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2022 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Imaging Services Subject to MPPR.
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_Jan, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2022 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1751-F_Diagnostic Imaging
								Services Subject to MPPR.
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2022 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1751-F_Diagnostic Imaging
								Services Subject to MPPR.
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2022 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2022 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1751-F_Diagnostic Imaging
								Services Subject to MPPR.
DWC Pharmaceutical Fee Schedule
Web address:
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after January 1,
								2022:
RVU22A (ZIP)
* GPCI2022 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2022 PW GPCI (without 1.0 Floor)"), column F
								("2022 PE GPCI"), and column G ("2022 MP GPCI") for the State of
								California
* 22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after April 1, 2022:
RVU22B (ZIP)
* GPCI2022 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2022 PW GPCI (without 1.0 Floor)"), column F
								("2022 PE GPCI"), and column G ("2022 MP GPCI") for the State of
								California
* 22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP)
* GPCI2022 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2022 PW GPCI (without 1.0 Floor)"), column F
								("2022 PE GPCI"), and column G ("2022 MP GPCI") for the State of
								California
* 22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after October 1,
								2022:
RVU22D (ZIP)
* GPCI2022 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2022 PW GPCI (without 1.0 Floor)"), column F
								("2022 PE GPCI"), and column G ("2022 MP GPCI") for the State of
								California
* 22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
Access the Relative Value File (ZIP) on the CMS
								website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after January 1,
								2022:
Section
								9789.19.1 Table A 2022, effective
								January 1, 2022 incorporates the Medicare locality GPCIs and anesthesia shares
								into updated locality-adjusted Anesthesia conversion factors.
Locality determined by Medicare county to locality
								index.
For services rendered on or after January 1,
								2022:
RVU22A (ZIP) (County to locality index)
* 22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2022:
RVU22B (ZIP) (County to locality index)
22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP) (County to
								locality index)
22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after October 1,
								2022:
RVU22D (County to locality index)
22LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after January 1,
								2022:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
"Zip Code to Carrier Locality File -- Revised
								11/15/2021" (ZIP), in the document "ZIP5_JAN22": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								11/15/2021" (ZIP) in the document: "ZIP5_requiring +4ext_dec2021_jan22", for
								the State of California ("CA")
For services rendered on or after April 1, 2022:
"Zip Code to Carrier Locality File -- Revised
								03/04/2022" (ZIP), in the document "ZIP5_JAN22": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								02/15/2022" (ZIP) in the document: "ZIP5_requiring +4ext_dec2021_jan22", for
								the State of California ("CA")
For services rendered on or after July 1, 2022:
"Zip Code to Carrier Locality File -- Revised
								05/13/2022" (ZIP), in the document "ZIP5_JUL22": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								05/13/2022" (ZIP) in the document: "ZIP5_requiring +4ext_jul22", for the State
								of California ("CA")
For services rendered on or after October 1,
								2022:
"Zip Code to Carrier Locality File -- Revised
								08/23/2022" (ZIP), folder name "ZPLC_OCT2022_v2", in the document
								"ZIP5_OCT2022_v2": Column A ("STATE"), column B ("ZIP CODE"), and column D
								("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								08/15/2022" (ZIP), folder name "ZIP5_requiring +4ext_oct22", in the document:
								"ZIP5_requiring +4ext_oct22", for the State of California ("CA")
Note:
Access the Zip Code files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html
Geographic Health Professional Shortage Area zip code
								data files
2022 Primary Care HPSA (ZIP)
2022 Mental Health HPSA (ZIP)
Access the HPSA files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By State & County)
Web address:
https://data.hrsa.gov/tools/shortage-area/hpsa-find
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
Web address:
https://data.hrsa.gov/tools/medicare/physician-bonus
Incident To Codes
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_Jan, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after January 1, 2022:
								Medi-Cal Rates file -- Updated 12/15/2021
For services rendered on or after January 15, 2022:
								Medi-Cal Rates file -- Updated 1/15/2022
For services rendered on or after February 15, 2022:
								Medi-Cal Rates file -- Updated 2/15/2022
For services rendered on or after March 15, 2022:
								Medi-Cal Rates file -- Updated 3/15/2022
For services rendered on or after April 15, 2022:
								Medi-Cal Rates file -- Updated 4/15/2022
For services rendered on or after May 15, 2022:
								Medi-Cal Rates file -- Updated 5/15/2022
For services rendered on or after June 15, 2022:
								Medi-Cal Rates file -- Updated 6/15/2022
For services rendered on or after July 15, 2022:
								Medi-Cal Rates file -- Updated 7/15/2022
For services rendered on or after August 15, 2022:
								Medi-Cal Rates file -- Updated 8/15/2022
For services rendered on or after September 15, 2022:
								Medi-Cal Rates file -- Updated 9/15/2022
For services rendered on or after October 15, 2022:
								Medi-Cal Rates file -- Updated 10/15/2022
For services rendered on or after November 15, 2022:
								Medi-Cal Rates file -- Updated 11/15/2022
For services rendered on or after December 15, 2022:
								Medi-Cal Rates file -- Updated 12/15/2022
For services rendered on or after January 15, 2023:
								Medi-Cal Rates file -- Updated 1/15/2023
The Medi-Cal Rates file can be accessed each month on
								the Medi-Cal Rates home page. Excerpts of the Medi-Cal Rates files are posted
								on the DWC website:
https://www.dir.ca.gov/dwc/FeeSchedules/Physician/Medi-Cal.asp
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after January 1,
								2022:
Medically Unlikely Edits
"Practitioner Services MUE Table -- Effective
								01-01-2022 -Posted December 15, 2021 (ZIP)," in the document
								"MCR_MUE_PractitionerServices_Eff_01-01-2022", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
For services rendered on or after April 1, 2022:
"Practitioner Services MUE Table -- Effective
								04-01-2022 -- Posted March 1, 2022 (ZIP)," in the document
								"MCR_MUE_PractitionerServices_Eff_04-01-2022", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
For services rendered on or after July 1, 2022:
"Practitioner Services MUE Table -- Effective
								07-01-2022 -- Posted June 1, 2022 (ZIP)," in the document
								"MCR_MUE_PractitionerServices_Eff_07-01-2022", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
For services rendered on or after October 1,
								2022:
"Practitioner Services MUE Table (ZIP)" -- Effective
								Oct. 1, 2022; Posted Aug. 31, 2022, in the document
								"MCR_MUE_PractitionerServices_Eff_10-01-2022", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
National Correct Coding Initiative (NCCI) Edits:
NCCI Policy Manual for Medicare Services -- Revision
								Date January 1, 2022
National Correct Coding Initiative Policy Manual for
								Medicare Services
Access on the CMS NCCI Policy Manual webpage
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after January 1,
								2022:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v280r1 effective January 1,
								2022
(639,319 records) 0001A/0591T -- 25999/96523 (posted
								12/16/2021)
Practitioner PTP Edits v280r1 effective January 1,
								2022
(611,489 records) 26010/01810 -- 36909/J2001 (posted
								12/16/2021)
Practitioner PTP Edits v280r1 effective January 1,
								2022
(590,131 records) 37140/0213T -- 60699/96523 (posted
								12/16/2021)
Practitioner PTP Edits v280r1 effective January 1,
								2022
(661,916 records): 61000/0213T -- U0003/U0004 (posted
								12/16/2021)
For services rendered on or after February 15,
								2022:
Practitioner PTP Edits v280r2 effective January 1,
								2022
(639,319 records) 0001A/0591T -- 25999/96523 (posted
								02/04/2022)
Practitioner PTP Edits v280r2 effective January 1,
								2022
(611,489 records) 26010/01810 -- 36909/J2001 (posted
								02/04/2022)
Practitioner PTP Edits v280r2 effective January 1,
								2022
(590,131 records) 37140/0213T -- 60699/96523 (posted
								02/04/2022)
Practitioner PTP Edits v280r2 effective January 1,
								2022
(661,916 records): 61000/0213T -- U0003/U0004 (posted
								02/04/2022)
For services rendered on or after April 1, 2022:
Practitioner PTP Edits v281r0 effective April 1,
								2022
(642,540 records) 0001A/0591T -- 25999/96523 (posted
								03/01/2022)
Practitioner PTP Edits v281r0 effective April 1,
								2022
(611,492 records) 26010/01810 -- 36909/J2001 (posted
								03/01/2022)
Practitioner PTP Edits v281r0 effective April 1,
								2022
(590,215 records) 37140/0213T -- 60699/96523 (posted
								03/01/2022)
Practitioner PTP Edits v281r0 effective April 1,
								2022
(662,677 records) 61000/0213T -- U0003/U0004 (posted
								03/01/2022)
For services rendered on or after July 1, 2022:
Practitioner PTP Edits v282r0 effective July 1,
								2022
(642,678 records) 0001A/0591T -- 25999/96523 (posted
								6/10/2022)
Practitioner PTP Edits v282r0 effective July 1,
								2022
(611,492 records) 26010/01810 -- 36909/J2001 (posted
								6/10/2022)
Practitioner PTP Edits v282r0 effective July 1,
								2022
(590,254 records) 37140/0213T -- 60699/96523 (posted
								6/10/2022)
Practitioner PTP Edits v282r0 effective July 1,
								2022
(663,766 records) 61000/0213T -- U0003/U0004 (posted
								6/10/2022)
For services rendered on or after October 1,
								2022:
Practitioner PTP Edits v283r0 (642,695 records)
								0001A/0591T -- 25999/96523 (ZIP) -- Effective Oct. 1, 2022; Posted Aug. 31,
								2022
Practitioner PTP Edits v283r0 (611,803 records)
								26010/01810 -- 36909/J2001 (ZIP) -- Effective Oct. 1, 2022; Posted Aug. 31,
								2022
Practitioner PTP Edits v283r0 (590,308 records)
								37140/0213T -- 60699/96523 (ZIP) -- Effective Oct. 1, 2022; Posted Aug. 31,
								2022
Practitioner PTP Edits v283r0 (663,947 records)
								61000/0213T -- U0003/U0004 (ZIP) -- Effective Oct. 1, 2022; Posted Aug. 31,
								2022
Access the Practitioner PTP Edits on the CMS website:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/PTP-Coding-Edits
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file on the CMS website
								covers all time periods.
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_JAN, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2022 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1751-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after January 1,
								2022:
RVU22A (ZIP), PPRRVU22_JAN, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2022:
RVU22B (ZIP), PPRRVU22_APR, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2022:
RVU22C -- Updated 06/17/2022 (ZIP), PPRRVU22_JUL,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2022 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1751-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2022:
RVU22D (ZIP), PPRRVU22_OCT, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2022 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1751-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2022 PFS Final Rule Physician Time (Zip)
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
Telehealth -- Services Accessible Through Telehealth
								(using audio and video telecommunication method and audio only
								telecommunication method) During the COVID-19 Public Health Emergency
For services rendered on or after January 1,
								2022:
List of Telehealth Services for Calendar Year 2022
								(ZIP) -- Updated 01/05/2022 in the document "List of Telehealth Services 2022
								Updated 05Jan2022"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2022, append modifier 95 to
								procedure code when delivered via telehealth.
For services rendered on or after July 1, 2022:
List of Telehealth Services for Calendar Year 2022
								(ZIP) -- Updated 06/17/2022 in the document "List of Telehealth
								Services_2022_Updated 16Jun2022"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2022, append modifier 95 to
								procedure code when delivered via telehealth.
(j) Services Rendered On or After February
					 15, 2023. Documents listed in the following table are incorporated by reference
					 and will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After
								February 15, 2023 & Mid-year Updates
Adjustment Factors -- Services Other than
								Anesthesia
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factor listed below)
2023 RVU budget neutrality adjustment factor: -1.60%
								(0.9840)
2023 Annual increase in the MEI: 3.8% (1.038)
Consolidated Appropriations Act, 2023, increase of
								2.5% (1.025)
Adjustment Factors -- Anesthesia
For anesthesia services:
(These factors have been incorporated into the
								conversion factors listed on section
								9789.19.1 Table A 2022)
2023 RVU budget neutrality adjustment factor: -1.60%
								(0.9840)
2023 Anesthesia practice expense and malpractice
								adjustment factor: 0.05% (1.0005)
2023 Annual increase in the MEI: 3.8% (1.038)
Consolidated Appropriations Act, 2023, increase of
								2.5% (1.025)
Anesthesia Base Units by CPT Code
File name: CY_2022_Anesthesia_Base_Units_110921
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $14.52
WC003 -- $44.97 for first page
$27.65 each additional page. Maximum of six pages
								absent mutual agreement ($183.22)
WC004 -- $44.97 for first page
$27.65 each additional page. Maximum of seven pages
								absent mutual agreement ($210.87)
WC005 -- $44.97 for first page
$27.65 each additional page. Maximum of six pages
								absent mutual agreement ($183.22)
WC007 -- $44.97 for first page
$27.65 each additional page. Maximum of six pages
								absent mutual agreement ($183.22)
WC008 -- $12.99 for up to the first 15 pages. $0.27
								for each additional page after the first 15 pages.
WC009 -- $12.99 for up to the first 15 pages. $0.27
								for each additional page after the first 15 pages.
WC010 -- $5.96 per x-ray
WC011 -- $12.99 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP)
* RVU23A (Excluding Attachment A)
* PPRRVU23_Jan
* OPPSCAP_Jan
* 23LOCCO
* GPCI2023
Excluding:
ANES2023
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP)
* RVU23B (Excluding Attachment A)
* PPRRVU23_APR
* OPPSCAP_APR
* 23LOCCO
* GPCI2023
Excluding:
ANES2023
For services rendered on or after July 1, 2023:
RVU23C (ZIP)
* RVU23C (Excluding Attachment A)
* PPRRVU23_JUL
* OPPSCAP_JUL
* 23LOCCO
* GPCI2023
Excluding:
ANES2023
For services rendered on or after October 1,
								2023:
RVU23D (ZIP)
* RVU23D (Excluding Attachment A)
* PPRRVU23_OCT
* OPPSCAP_OCT
* 23LOCCO
* GPCI2023
Excluding:
ANES2023
Access the Relative Value File on the CMS website:
https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
Conversion Factors adjusted for MEI, Relative Value
								Scale adjustment factors, and application of Consolidated Appropriations Act,
								2023, increase
Anesthesia Conversion Factor: $28.75
[See Section
								9789.19.1 Table A effective
								2.15.2023, Effective for services on or after February 15, 2023 for
								GPCI-Adjusted Conversion Factors by locality]
Other Services Conversion Factor: $47.21
Current Procedural Terminology (CPT®)
CPT 2023
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99242 through 99245 (see §
															9789.12.12)
99252 through 99255 (see §
															9789.12.12)
99417 (See §
															9789.12.11. Use code G2212)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_Jan,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23_APR,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "6" in column S,
								labeled "Mult Proc" (Modifier 51), also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after February 15,
								2023:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU23A -- Updated 01/18/23 (ZIP), RVU23A (PDF
								document)
For services rendered on or after April 1, 2023:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU23B -- Updated 02/27/23 (ZIP), RVU23B (PDF
								document)
For services rendered on or after July 1, 2023:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU23C (ZIP), RVU23C (PDF document)
For services rendered on or after October 1,
								2023:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction of the TC diagnostic
								imaging
99 = Concept does not apply
RVU23D (ZIP), RVU23D (PDF document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_Jan,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2023 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1770-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23_APR,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2023 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1770-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2023 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "88" in column AB,
								labeled, "Diagnostic Imaging Family Indicator." Also listed in CY 2023 PFS
								Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Imaging Services Subject to MPPR.
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_Jan,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2023 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23_APR,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2023 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2023 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1770-F_Diagnostic Imaging
								Services Subject to MPPR.
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "4" in column S,
								labeled, "Mult Proc." Also listed in CY 2023 PFS Final Rule Multiple Procedure
								Payment Reduction Files (ZIP), in the document CMS-1770-F_Diagnostic Imaging
								Services Subject to MPPR.
DWC Pharmaceutical Fee Schedule
Web address:
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP)
* GPCI2023 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2023 PW GPCI (with 1.0 Floor)"), column F ("2023
								PE GPCI"), and column G ("2023 MP GPCI") for the State of California
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP)
* GPCI2023 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2023 PW GPCI (with 1.0 Floor)"), column F ("2023
								PE GPCI"), and column G ("2023 MP GPCI") for the State of California
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after July 1, 2023:
RVU23C (ZIP)
* GPCI2023 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2023 PW GPCI (with 1.0 Floor)"), column F ("2023
								PE GPCI"), and column G ("2023 MP GPCI") for the State of California
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after October 1,
								2023:
RVU23D (ZIP)
* GPCI2023 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2023 PW GPCI (with 1.0 Floor)"), column F ("2023
								PE GPCI"), and column G ("2023 MP GPCI") for the State of California
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
Access the Relative Value File (ZIP) on the CMS
								website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after February 15,
								2023:
Section
								9789.19.1 Table A effective
								2.15.2023 incorporates the Medicare locality GPCIs and anesthesia shares into
								updated locality-adjusted Anesthesia conversion factors.
Locality determined by Medicare county to locality
								index.
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP) (County to locality
								index)
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP) (County to locality
								index)
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
For services rendered on or after July 1, 2023:
RVU23C (ZIP) (County to locality index)
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
For services rendered on or after October 1,
								2023:
RVU23D (ZIP) (County to locality index)
* 23LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after February 15,
								2023:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
"Zip Code to Carrier Locality File -- Revised
								11/15/2022" (ZIP), in the document "ZIP5_JAN23": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								11/15/2022" (ZIP) in the document: "ZIP5_requiring +4ext_dec2022_jan23", for
								the State of California ("CA")
For services rendered on or after April 1, 2023:
"Zip Code to Carrier Locality File -- Revised
								02/17/2023" (ZIP), in the document "ZIP5_APR23": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								02/17/2023" (ZIP) in the document: "ZIP5_requiring +4ext_apr23", for the State
								of California ("CA")
For services rendered on or after July 1, 2023:
"Zip Code to Carrier Locality File -- Revised
								05/16/2023" (ZIP), in the document "ZIP5_JUL23": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								05/16/2023" (ZIP) in the document: "ZIP5_requiring +4ext_jul23", for the State
								of California ("CA")
For services rendered on or after October 1,
								2023:
"Zip Code to Carrier Locality File -- Revised
								08/16/2023" (ZIP), in the document "ZIP5_OCT2023": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								08/16/2023" (ZIP) in the document: "ZIP5_requiring +4ext_oct23", for the State
								of California ("CA")
Note:
Access the Zip Code files on the CMS website:
https://www.cms.gov/medicare/payment/prospective-payment-systems
Geographic Health Professional Shortage Area zip code
								data files
2023 Primary Care HPSA (ZIP)
2023 Mental Health HPSA (ZIP)
Access the HPSA files on the CMS website:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By State & County)
Web address:
https://data.hrsa.gov/tools/shortage-area/hpsa-find
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
Web address:
https://data.hrsa.gov/tools/medicare/physician-bonus
Incident To Codes
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_JAN,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23 APR,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "5" in column N,
								labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after February 15,
								2023:
Medi-Cal Rates file -- Updated 2/15/2023
For services rendered on or after March 15,
								2023:
Medi-Cal Rates file -- Updated 3/15/2023
For services rendered on or after April 15,
								2023:
Medi-Cal Rates file -- Updated 4/15/2023
For services rendered on or after May 15, 2023:
Medi-Cal Rates file -- Updated 5/15/2023
For services rendered on or after June 15, 2023:
Medi-Cal Rates file -- Updated 6/15/2023
For services rendered on or after July 15, 2023:
Medi-Cal Rates file -- Updated 7/15/2023
For services rendered on or after August 15,
								2023:
Medi-Cal Rates file -- Updated 8/15/2023
For services rendered on or after September 15,
								2023:
Medi-Cal Rates file -- Updated 9/15/2023
For services rendered on or after October 15,
								2023:
Medi-Cal Rates file -- Updated 10/15/2023
For services rendered on or after November 15,
								2023:
Medi-Cal Rates file -- Updated 11/15/2023
For services rendered on or after December 15,
								2023:
Medi-Cal Rates file -- Updated 12/15/2023
For services rendered on or after January 16,
								2024:
Medi-Cal Rates file -- Updated 1/16/2024
The Medi-Cal Rates file can be accessed each month on
								the Medi-Cal Rates home page. Excerpts of the Medi-Cal Rates files are posted
								on the DWC website:
https://www.dir.ca.gov/dwc/FeeSchedules/Physician/Medi-Cal.asp
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after February 15,
								2023:
Medically Unlikely Edits
"Practitioner Services MUE Table (ZIP) -- Effective
								Jan. 1, 2023; Posted Dec. 1, 2022," in the document
								"MCR_MUE_PractitionerServices_Eff_02-15-2023", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
For services rendered on or after July 1, 2023:
"Practitioner Services MUE Table (ZIP) -- Effective
								July 1, 2023; Posted June. 1, 2023," in the document
								"MCR_MUE_PractitionerServices_Eff_07-01-2023", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
For services rendered on or after October 1,
								2023:
"Practitioner Services MUE Table (ZIP) -- Effective
								October 1, 2023; Posted September 1, 2023," in the document
								"MCR_MUE_PractitionerServices_Eff_10-01-2023", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
National Correct Coding Initiative (NCCI) Edits:
For services on or after February 15, 2023:
National Correct Coding Initiative Policy Manual for
								Medicare Services
NCCI Policy Manual for Medicare (ZIP) -- Effective
								January 1, 2023, posted December 1, 2022
Access on the CMS NCCI Policy Manual webpage
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after February 15,
								2023:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v290r1 (661,878 Records)
								0001A/0591T -- 25999/96523 (ZIP) -- Effective Jan. 1, 2023; Posted Dec. 5,
								2022
Practitioner PTP Edits v290r1 (614,255 Records)
								26010/01810 -- 36909/J2001 (ZIP) -- Effective Jan. 1, 2023; Posted Dec. 5,
								2022
Practitioner PTP Edits v290r1 (595,695 Records)
								37140/0213T -- 60699/96523 (ZIP) -- Effective Jan. 1, 2023; Posted Dec. 5,
								2022
Practitioner PTP Edits v290r1 (669,559 Records)
								61000/0213T -- U0003/U0004 (ZIP) -- Effective Jan. 1, 2023; Posted Dec. 5,
								2022
For services rendered on or after July 1, 2023:
Practitioner PTP Edits v292r0 (662,411 Records)
								0001A/0591T -- 25999/96523 (ZIP) -- Effective July 1, 2023; Posted Jun. 1,
								2023
Practitioner PTP Edits v292r0 (614,258 Records)
								26010/01810 -- 36909/J2001 (ZIP) -- Effective July 1, 2023; Posted Jun. 1,
								2023
Practitioner PTP Edits v292r0 (595,707 Records)
								37140/0213T -- 60699/96523 (ZIP) -- Effective July 1, 2023; Posted Jun. 1,
								2023
Practitioner PTP Edits v292r0 (669,603 Records)
								61000/0213T -- U0003/U0004 (ZIP) -- Effective July 1, 2023; Posted Jun. 1,
								2023
For services rendered on or after October 1,
								2023:
Practitioner PTP Edits v293r1 (662,411 Records)
								0001A/0591T -- 25999/96523 (ZIP) -- Effective October 1, 2023; Posted September
								14, 2023
Practitioner PTP Edits v293r1 (614,258 Records)
								26010/01810 -- 36909/J2001 (ZIP) -- Effective October 1, 2023; Posted September
								14, 2023
Practitioner PTP Edits v293r1 (595,709 Records)
								37140/0213T -- 60699/96523 (ZIP) -- Effective October 1, 2023; Posted September
								14, 2023
Practitioner PTP Edits v293r1 (669,619 Records)
								61000/0213T -- U0003/U0004 (ZIP) -- Effective October 1, 2023; Posted September
								14, 2023
Access the Practitioner PTP Edits on the CMS website:
https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-procedure-procedure-ptp-edits
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file on the CMS website
								covers all time periods.
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_JAN,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Diagnostic Ophthalmology Services Subject to MPPR.
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23_APR,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Diagnostic Ophthalmology Services Subject to MPPR.
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Ophthalmology Services Subject to MPPR.
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "7" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Diagnostic Ophthalmology Services Subject to MPPR.
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after February 15,
								2023:
RVU23A -- Updated 01/18/23 (ZIP), PPRRVU23_JAN,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after April 1, 2023:
RVU23B -- Updated 02/27/23 (ZIP), PPRRVU23_APR,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2023 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1770-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after July 1, 2023:
RVU23C (ZIP), PPRRVU23_JUL, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
For services rendered on or after October 1,
								2023:
RVU23D (ZIP), PPRRVU23_OCT, number "5" in column S,
								labeled "Mult Proc" (Modifier 51). Also listed in CY 2023 PFS Final Rule
								Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1770-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2023 PFS Final Rule Physician Work Time (Zip)
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
Telehealth -- Services Accessible Through Telehealth
								(using audio and video telecommunication method and audio only
								telecommunication method) During the COVID-19 Public Health Emergency
For services rendered on or after February 15,
								2023:
List of Telehealth Services for Calendar Year 2023
								(ZIP) -- Updated 11/02/2022 in the document "CMS-1770-F_CY2023_Final List of
								Medicare Telehealth Services"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2023, append modifier 95 to
								procedure code when delivered via telehealth.
For services rendered on or after April 1, 2023:
List of Telehealth Services for Calendar Year 2023
								(ZIP) -- Updated 02/13/2023 in the document "List of Telehealth Services for
								Calendar Year 2023 Updated 13Feb2023"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2023, append modifier 95 to
								procedure code when delivered via telehealth.
For services rendered on or after July 1, 2023:
List of Telehealth Services for Calendar Year 2023
								(ZIP) -- Updated 05/09/2023 in the document "List of Telehealth Services for
								Calendar Year 2023 Updated 09May2023"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
In accord with CPT 2023, append modifier 95 to
								procedure code when delivered via telehealth
(k) Services Rendered On or After February
					 15, 2024. Documents listed in the following table are incorporated by reference
					 and will be made available upon request to the Administrative Director.
Document/Data
Services Rendered On or After
								February 15, 2024 & Mid-year Updates
Adjustment Factors -- Services Other than
								Anesthesia
For all services other than anesthesia:
(These factors have been incorporated into the
								conversion factor listed below)
2024 RVU budget neutrality adjustment factor: -2.18%
								(0.9782)
2024 Annual increasein the MEI: 4.6% (1.046)
Consolidated Appropriations Act, 2023, increase of
								1.25% (1.0125) (effective from 2/15/2024 through 3/31/2024)
Consolidated Appropriations Act, 2024, increase of
								2.93% (1.0293) (effective April 1, 2024)
Adjustment Factors -- Anesthesia
For anesthesia services:
(These factors have been incorporated into the
								conversion factors listed on section
								9789.19.1 Table A Effective
								2/15/2024)
2024 RVU budget neutrality adjustment factor: -2.18%
								(0.9782)
2024 Anesthesia practice expense and malpractice
								adjustment factor: 0.11% (1.0011)
2024 Annual increase in the MEI: 4.6% (1.046)
Consolidated Appropriations Act, 2023, increase of
								1.25% (1.0125) (effective from 2/15/2024 through 3/31/2024)
Consolidated Appropriations Act, 2024, increase of
								2.93% (1.0293) (effective April 1, 2024)
Anesthesia Base Units by CPT Code
File name: CY 2022 Anesthesia Base Units 110921
California-Specific Codes
WC001 -- Not reimbursable
WC002 -- $15.19
WC003 -- $47.04 for first page
$28.92 each additional page. Maximum of six pages
								absent mutual agreement ($191.64)
WC004 -- $47.04 for first page
$28.92 each additional page. Maximum of seven pages
								absent mutual agreement ($220.56)
WC005 -- $47.04 for first page
$28.92 each additional page. Maximum of six pages
								absent mutual agreement ($191.64)
WC007 -- $47.04 for first page
$28.92 each additional page. Maximum of six pages
								absent mutual agreement ($191.64)
WC008 -- $13.59 for up to the first 15 pages. $0.28
								for each additional page after the first 15 pages.
WC009 -- $13.59 for up to the first 15 pages. $0.28
								for each additional page after the first 15 pages.
WC010 -- $6.23 per x-ray
WC011 -- $13.59 per scan
WC012 -- No Fee Prescribed/Non Reimbursable absent
								agreement
CMS' Medicare National Physician Fee Schedule
								Relative Value File [Zip]
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP)
* RVU24A (Excluding Attachment A)
* PPRRVU24_Jan
* OPPSCAP_Jan
* 24LOCCO
* GPCI2024
Excluding:
ANES2024
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP)
* RVU24B (Excluding Attachment A)
* PPRRVU24_APR
* OPPSCAP_APR
* 24LOCCO
* GPCI2024
Excluding:
ANES2024
Access the Relative Value File on the CMS website:
https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
Conversion Factor -- Anesthesia (before GPCI
								adjustment)
For services rendered on or after February 15, 2024
								and on or before March 31, 2024:
Adjusted for MEI, Relative Value Scale adjustment
								factors, and application of Consolidated Appropriations Act, 2023,
								increase
Anesthesia Conversion Factor: $29.0948
Adjusted for application of Consolidated
								Appropriations Act, 2024 increase
[See Section
								9789.19.1 Table A Effective
								2.15.2024 through 3.31.2024, effective for services on or after February 15,
								2024 and on or before March 31, 2024, for GPCI-Adjusted Conversion Factors by
								locality]
For services rendered on or after April 1, 2024:
Anesthesia Conversion Factor: $29.5775
[See Section
								9789.19.1 Table A Effective
								04.1.2024, effective for services on or after April 1, 2024, for GPCI-Adjusted
								Conversion Factors by locality]
Conversion Factor -- Services Other than
								Anesthesia
For services rendered on or after February 15, 2024
								and on or before March 31, 2024:
Adjusted for MEI, Relative Value Scale adjustment
								factor, and application of Consolidated Appropriations Act, 2023, increase
Other Services Conversion Factor: $47.72
For services rendered on or after April 1, 2024:
Other Services Conversion Factor: $48.51
Current Procedural Terminology (CPT®)
CPT 2024
https://commerce.ama-assn.org/store/
Current Procedural Terminology CPT codes that shall
								not be used
Do not use CPT codes:
27215 (Use G0412)
27216 (Use G0413)
27217 (Use G0414)
27218 (Use G0415)
76140 (see §
															9789.17.2)
90889 (See §
															9789.14. Use code WC005 code)
97014 (Use G0283)
99075 (see Medical-Legal fee schedule, §
															9795)
99080 (see §
															9789.14)
99242 through 99245 (see §
															9789.12.12)
99252 through 99255 (see §
															9789.12.12)
99417 (See §
															9789.12.11. Use code G2212)
99455 and 99456
Diagnostic Cardiovascular Procedure CPT codes subject
								to the MPPR
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_Jan,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Diagnostic Cardiovascular Services Subject to MPPR
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_Apr,
								number "6" in column S, labeled "Mult Proc" (Modifier 51), also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Diagnostic Cardiovascular Services Subject to MPPR
Diagnostic Imaging Family Indicator Description
For services rendered on or after February 15,
								2024:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU24A -- Updated 01/03/2024 (ZIP), RVU24A (PDF
								document)
For services rendered on or after April 1, 2024:
Diagnostic Imaging Family Indicator:
88 = Subject to the reduction
99 = Concept does not apply
RVU24B -- Updated 03/18/2024 (ZIP), RVU24B (PDF
								document)
Diagnostic Imaging Family Procedures Subject to the
								MPPR
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_Jan,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2024 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1784-F_Diagnostic Imaging Services Subject to
								MPPR.
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_Apr,
								number "88" in column AB, labeled, "Diagnostic Imaging Family Indicator." Also
								listed in CY 2024 PFS Final Rule Multiple Procedure Payment Reduction Files
								(ZIP), in the document CMS-1784-F_Diagnostic Imaging Services Subject to
								MPPR.
Diagnostic Imaging Multiple Procedures Subject to the
								MPPR
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_Jan,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2024 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1784-F_Diagnostic Imaging Services Subject to MPPR.
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_Apr,
								number "4" in column S, labeled, "Mult Proc." Also listed in CY 2024 PFS Final
								Rule Multiple Procedure Payment Reduction Files (ZIP), in the document
								CMS-1784-F_Diagnostic Imaging Services Subject to MPPR.
DWC Pharmaceutical Fee Schedule
Web address:
http://www.dir.ca.gov/dwc/OMFS9904.htm#8
Geographic Practice Cost Index (GPCI) by locality
								(Other than anesthesia services)
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP)
* GPCI2024 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2024 PW GPCI (with 1.0 Floor)"), column F ("2024
								PE GPCI"), and column G ("2024 MP GPCI") for the State of California
* 24LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP)
* GPCI2024 -- Column C ("Locality Number"), column D
								("Locality Name"), column E ("2024 PW GPCI (with 1.0 Floor)"), column F ("2024
								PE GPCI"), and column G ("2024 MP GPCI") for the State of California
* 24LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California
Access the Relative Value File (ZIP) on the CMS
								website:
https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCIs) by locality
								and anesthesia shares (Anesthesia)
For services rendered on or after February 15,
								2024:
Section
								9789.19.1 Table A Effective
								2.15.2024 incorporates the Medicare locality GPCIs and anesthesia shares into
								updated locality-adjusted Anesthesia conversion factors.
Locality determined by Medicare county to locality
								index.
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP) (County to
								locality index)
* 24LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP) (County to
								locality index)
* 24LOCCO -- Column B ("Locality Number"), column C
								("State"), column D ("Fee Schedule Area"), and column E ("Counties") for the
								State of California ("CA")
Also, see Zip Code mapping files listed below.
Geographic Practice Cost Index (GPCI) locality
								mapping
For services rendered on or after February 15,
								2024:
Zip Code files mapping zip codes to GPCI locality
								(for "other than anesthesia services" and anesthesia services)
"Zip Code to Carrier Locality File -- Revised
								11/15/2023 (ZIP)", in the document "ZIP5_JAN24": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised
								11/15/2023 (ZIP)" in the document: "ZIP5_requiring +4ext_dec23_jan24", for the
								State of California ("CA")
For services rendered on or after April 1, 2024:
"Zip Code to Carrier Locality File -- Revised
								2/15/2024 (ZIP)", in the document "ZIP5 APR2024": Column A ("STATE"), column B
								("ZIP CODE"), and column D ("LOCALITY") for the State of California ("CA")
"Zip Codes requiring 4 extension -- Revised 2/15/2024
								(ZIP)" in the document: "ZIP5_requiring +4ext_apr24", for the State of
								California ("CA")
Note:
Access the Zip Code files on the CMS website:
https://www.cms.gov/medicare/payment/fee-schedules
Geographic Health Professional Shortage Area zip code
								data files
2024 Primary Care HPSA (ZIP)
2024 Mental Health HPSA (ZIP)
Access the HPSA files on the CMS website:
https://www.cms.gov/medicare/payment/fee-for-service-providers/physician-bonuses-health-professional-shortage-areas-hpsas
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By State & County)
Web address:
https://data.hrsa.gov/tools/shortage-area/hpsa-find
Health Resources and Services Administration:
								Geographic HPSA shortage area query (By Address)
Web address:
https://data.hrsa.gov/tools/medicare/physician-bonus
Incident To Codes
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_JAN,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_APR,
								number "5" in column N, labeled, "PCTC IND," (PC/TC Indicator)
Medi-Cal Rates -- DHCS
Pursuant to section
								9789.13.2, the Medi-Cal Rates
								file's "Basic Rate" is used in calculating maximum fee for
								physician-administered drugs, biologicals, vaccines or blood products, by date
								of service.
For services rendered on or after February 15,
								2024:
Medi-Cal Rates file -- Updated 2/15/2024
For services rendered on or after March 15,
								2024:
Medi-Cal Rates file -- Updated 3/15/2024
For services rendered on or after April 15,
								2024:
Medi-Cal Rates file -- Updated 4/15/2024
The Medi-Cal Rates file can be accessed each month on
								the Medi-Cal Rates home page. Excerpts of the Medi-Cal Rates files are posted
								on the DWC website:
https://www.dir.ca.gov/dwc/FeeSchedules/Physician/Medi-Cal.asp
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after February 15,
								2024:
Medically Unlikely Edits
"Practitioner Services MUE Table (ZIP) -- Effective
								January 1, 2024; Posted Dec. 5, 2023", in the document
								"MCR_MUE_PractitionerServices_Eff_01-01-2024_R1", excluding all codes listed
								with Practitioner Services MUE Value of "0" (zero)
For services rendered on or after April 1, 2024:
"Practitioner Services MUE Table (ZIP) -- Effective
								April 1, 2024; Posted March 1, 2024", in the document
								"MCR_MUE_PractitionerServices_Eff_04-01-2024", excluding all codes listed with
								Practitioner Services MUE Value of "0" (zero)
Excerpts of the MUE Tables are posted on the DWC
								website:
http://www.dir.ca.gov/dwc/OMFS9904.htm#7
National Correct Coding Initiative (NCCI) Edits:
For services on or after February 15, 2024:
National Correct Coding Initiative Policy Manual for
								Medicare Services
Medicare NCCI Policy Manual (ZIP) -- Effective
								January 1, 2024, posted December 1, 2023
Access on the CMS NCCI Policy Manual webpage
National Correct Coding Initiative (NCCI) Edits:
For services rendered on or after February 15,
								2024:
Practitioner Procedure to Procedure (PTP) Edits
Practitioner PTP Edits v300r0 (636,288 Records)
								0001A/0591T -- 25391/G0471 (ZIP) -- Effective Jan. 1, 2024; Posted Dec. 1,
								2023
Practitioner PTP Edits v300r0 (635,881 Records)
								25392/01810 -- 36833/G0471 (ZIP) -- Effective Jan. 1, 2024; Posted Dec. 1,
								2023
Practitioner PTP Edits v300r0 (635,917 Records)
								36834/01844 -- 61592/G0471 (ZIP) -- Effective Jan. 1, 2024; Posted Dec. 1,
								2023
Practitioner PTP Edits v300r0 (634,827 Records)
								61595/0213T -- U0003/U0004 (ZIP) -- Effective Jan. 1, 2024; Posted Dec. 1,
								2023
For services rendered on or after April 1, 2024:
Practitioner PTP Edits v301r0 (645,065 Records)
								0001A/0591T -- 25492/G0471 (ZIP) -- Effective Apr. 1, 2024; Posted Mar. 1,
								2024
Practitioner PTP Edits v301r0 (645,145 Records)
								25500/01810 -- 37221/J2001 (ZIP) -- Effective Apr. 1, 2024; Posted Mar. 1,
								2024
Practitioner PTP Edits v301r0 (644,853 Records)
								37222/11000 -- 62140/G0471 (ZIP) -- Effective Apr. 1, 2024; Posted Mar. 1,
								2024
Practitioner PTP Edits v301r0 (610,026 Records)
								62141/0213T -- U0003/U0004 (ZIP) -- Effective Apr. 1, 2024; Posted Mar. 1,
								2024
Access the Practitioner PTP Edits on the CMS website:
https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits
Note: the Practitioner PTP Edits excel file
								maintained by CMS contains effective date and deletion date (if any) for each
								column 1/column 2 pair. Therefore, the most recent file on the CMS website
								covers all time periods.
Ophthalmology Procedure CPT codes subject to the
								MPPR
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_JAN,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Diagnostic Ophthalmology Services Subject to MPPR
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_APR,
								number "7" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Diagnostic Ophthalmology Services Subject to MPPR
Physical Therapy Multiple Procedure Payment
								Reduction: "Always Therapy" Codes; and Acupuncture and Chiropractic Codes
For services rendered on or after February 15,
								2024:
RVU24A -- Updated 01/03/2024 (ZIP), PPRRVU24_JAN,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Separately Payable Therapy Services Subject to MPPR. In
								addition, CPT codes: 97810, 97811, 97813, 97814, 98940, 98941, 98942,
								98943
For services rendered on or after April 1, 2024:
RVU24B -- Updated 03/18/2024 (ZIP), PPRRVU24_APR,
								number "5" in column S, labeled "Mult Proc" (Modifier 51). Also listed in CY
								2024 PFS Final Rule Multiple Procedure Payment Reduction Files (ZIP), in the
								document CMS-1784-F_Separately Payable Therapy Services Subject to MPPR.
In addition, CPT codes: 97810, 97811, 97813, 97814,
								98940, 98941, 98942, 98943
Physician Time
CY 2024 PFS Final Rule Physician Work Time -- Updated
								12/19/2023 (ZIP)
Splints and Casting Supplies
The OMFS Durable Medical Equipment, Prosthetics,
								Orthotics, Supplies (DMEPOS) Fee Schedule applicable to the date of
								service.
Telehealth -- Services Accessible Through Telehealth
								(using audio and video telecommunication method and audio only
								telecommunication method)
For services rendered on or after February 15,
								2024:
List of Telehealth Services for Calendar Year 2024
								(ZIP) -- Updated 11/13/2023 in the document "CY 2024 PFS Final Rule List of
								Medicare Telehealth Services_V13Nov2023"
File specifies codes that may be billed when service
								is rendered using audio only telecommunication and codes that may only be
								billed if service is rendered using a telecommunication method that includes
								both audio and video.
See section
								9789.12.2, subdivision (d) for
								Place of Service Codes.
In accord with CPT 2024, append modifier 95 to
								procedure code when delivered via telehealth.
Note: Authority cited: Sections 133, 4603.5, 5307.1 and
						  5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor
						  Code.
Note: Authority: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  5307.1 and
						  5307.11, Labor
						  Code.