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

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director incorporates
					 by reference, the Centers for Medicare and Medicaid Services' (CMS) Hospital
					 Outpatient Prospective Payment System (HOPPS) certain addenda published in the
					 Federal Register notices announcing revisions in the Medicare payment rates.
					 See Section
					 9789.39(b) for the
					 adopted payment system addenda by date of service.
(b) For services rendered on or after July
					 15, 2005, the Administrative Director incorporates by reference, the Centers
					 for Medicare and Medicaid Services' (CMS) Hospital Inpatient Prospective
					 Payment Systems (IPPS) certain tables published in the Federal Register notices
					 announcing revisions in the Medicare payment rates. See Section
					 9789.39(b) for the
					 adopted payment system tables by date of service.
(c) For services rendered on or after July
					 15, 2005, the Administrative Director incorporates by reference, the Hospital
					 Inpatient Prospective Payment Systems (IPPS) "Payment Impact File" published by
					 the federal Centers for Medicare & Medicaid Services (CMS) in effect as of
					 the date the Administrative Director Order becomes effective, which document is
					 found at
http://www.cms.hhs.gov/AcuteInpatientPPS/
.
(d) For services rendered on or after
					 September 1, 2014, but before December 15, 2016, the Administrative Director
					 incorporates by reference, the Medicare Physician Fee Schedule "Relative Value
					 File" published by the federal Centers for Medicare & Medicaid Services
					 (CMS), which document is found at
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/PhysicianFeeSched/
.
					 See Section
					 9789.39(b) for the
					 adopted Relative Value File by date of service.
(e) For services rendered on or after
					 December 15, 2016, the Administrative Director incorporates by reference the
					 Centers for Medicare and Medicaid Services' (CMS) Ambulatory Surgical Centers
					 Payment System particular columns of certain addenda published in the Federal
					 Register notices announcing revisions in the Medicare payment rates. See
					 Section 9789.39(b) for the
					 adopted payment system addenda by date of service.
(f) The Administrative Director incorporates
					 by reference certain sections of the Centers for Medicare and Medicaid
					 Services' (CMS) Claims Processing Manual, Chapter 4. See Section
					 9789.39(b) for the
					 adopted sections of Chapter 4, by date of service.
(g) The Administrative Director incorporates
					 by reference certain sections of the Centers for Medicare and Medicaid
					 Services' Integrated Outpatient Code Editor (I/OCE) CMS Specifications. See
					 Section 9789.39(b) for the
					 adopted sections of I/OCE CMS Specifications, by date of service.
(h) The Administrative Director incorporates
					 by reference the American Medical Associations' "Current Procedural
					 Terminology," 4th Edition, annual revision in effect as of the date the
					 Administrative Director Order becomes effective. Copies of the Current
					 Procedural Terminology may be purchased from the American Medical Association:
ORDER DEPARTMENT AMERICAN MEDICAL ASSOCIATION
P.O. BOX 930876
ATLANTA, GA 31193-0876
Or over the internet at:
www.amapress.com
Or through the American Medical Association's toll free
						order line:
(800) 621-8335.
(i) The Administrative Director incorporates
					 by reference CMS' Alphanumeric "Healthcare Common Procedure Coding System
					 (HCPCS)" annual revision in effect as of the date the Administrative Director
					 Order becomes effective. Copies of the Healthcare Common Procedure Coding
					 System (HCPCS) may be purchased from the American Medical Association:
ORDER DEPARTMENT AMERICAN MEDICAL ASSOCIATION
P.O. BOX 930876
ATLANTA, GA 31193-0876
Or over the internet at:
www.amapress.com
Or through the American Medical Association's toll free
						order line:
(800) 621-8335.
1. New
						section filed 1-2-2004 as an emergency; operative 1-2-2004 (Register 2004, No.
						2). A Certificate of Compliance must be transmitted to OAL by 5-3-2004 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 1-2-2004 order, including
						amendment of subsection (a), transmitted to OAL 4-30-2004 and filed 6-15-2004
						(Register 2004, No. 25).
3. Amendment filed 12-27-2012; operative
						1-1-2013 as a file and print only pursuant to Government Code section
						11340.9(g)
						(Register 2012, No. 52).
4. Amendment of subsections (c)-(e) filed
						3-29-2013; operative 4-1-2013 pursuant to Labor Code section
						5307.1(g)(2).
						Submitted to OAL for filing and printing only pursuant to Labor Code section
						5307.1(g)(2)
						(Register 2013, No. 13).
5. New subsection (d) and subsection
						relettering filed 6-3-2014; operative 9-1-2014 as a file and print only
						pursuant to Government Code section
						11340.9(g)
						(Register 2014, No. 23).
6. Amendment of subsection (d), new
						subsection (e) and subsection relettering filed 12-15-2016; operative
						12-15-2016 as a file and print only pursuant to Government Code section
						11340.9(g)
						(Register 2016, No. 51).
7. New subsections (f) and (g) and
						subsection relettering filed 5-8-2018; operative 3-15-2018 pursuant to Labor
						Code section
						5307.1(g)(2).
						Submitted to OAL for filing and printing only pursuant to Labor Code section
						5307.1(g)(2)
						(Register 2018, No. 19).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4603.2 and
						  5307.1, Labor
						  Code.