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 9789.12.8 - Status Codes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Medicare Status Codes have been adapted for workers'
						compensation and have the following meanings:
A =
Active Code. These codes are paid
								separately under the physician fee schedule. There will be RVUs for codes with
								this status.
B =
Bundled Code. Payment for covered
								services are always bundled into payment for other services not specified. If
								RVUs are shown, they are not used for payment. If these services are covered,
								payment for them is subsumed by the payment for the services to which they are
								incident. (An example is a telephone call from a hospital nurse regarding care
								of a patient).
C =
If payable, these codes will be paid
								using the RVUs listed in the Centers for Medicare and Medicaid Services (CMS')
								National Physician Fee Schedule Relative Value File, or if no RVUs are
								assigned, then by "By Report," generally following review of documentation such
								as an operative report.
E =
If payable:
(a) HCPCS codes beginning with "J" or
								"P", maximum fee is determined according section
								9789.13.2.
(b) Other codes are paid under the
								applicable fee schedule contained in Section
								9789.30-9789.70, or if none of
								those schedules is applicable the code is payable "By Report."
I =
Except as otherwise provided, not valid
								code for workers' compensation physician billing. See section
								9789.12.3.
J =
Anesthesia Services. The intent of this
								value is to facilitate the identification of anesthesia services. There are no
								RVUs and no payment amounts for these codes in the National Physician Fee
								Schedule Relative Value File. Instead, the Anesthesia Base Units file is to be
								used to determine the base units for these codes.
M =
Measurement codes. Used for reporting
								purposes only.
N =
If payable, these CPT codes are paid
								using the listed RVUs; but if no RVUs are listed, then By Report. See section
								9789.12.3.
P =
Bundled/Excluded Codes. There are no
								RVUs and no payment amounts for these services. No separate payment should be
								made for them under the fee schedule.
--If the item or service is covered as
								incident to a physician service and is provided on the same day as a physician
								service, payment for it is bundled into the payment for the physician service
								to which it is incident. (An example is an elastic bandage furnished by a
								physician incident to physician service.)
--If the item or service is covered as
								other than incident to a physician service, it is excluded from the fee
								schedule (i.e., colostomy supplies) and should be paid under the other portions
								of the fee schedule.
Q =
Therapy functional information code
								(used for required Medicare reporting purposes only; not used for workers'
								compensation).
R =
If payable, these codes will be paid
								pursuant to section
								9789.12.3.
T =
Injections. There are RVUS and payment
								amounts for these services, but they are only paid if there are no other
								services payable under the physician fee schedule billed on the same date by
								the same provider. If any other services payable under the physician fee
								schedule are billed on the same date by the same provider, these services are
								bundled into the physician services for which payment is made.
X =
No RVUS or payment amounts are shown
								for these codes. If payable, these codes are paid under the applicable fee
								schedule contained in Sections
								9789.30 -
								9789.70, or if none of those
								schedules is applicable the code is payable "By Report." (Examples of services
								payable under another fee schedule are ambulance services and clinical
								diagnostic laboratory services.)
1. New
						section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and
						print only pursuant to Government Code section
						11340.9(g)
						(Register 2013, No. 39).
2. Amendment of table -- items C and N
						filed 12-26-2013; operative 1-1-2014. Submitted to OAL as a file and print only
						pursuant to Government Code section
						11340.9(g)
						(Register 2013, No. 52).
3. Amendment of table adding new item Q
						filed 3-23-2016; operative 1-1-2016 pursuant to Labor Code section
						5307.1(g)(2).
						Submitted to OAL for filing and printing only pursuant to Labor Code section
						5307.1(g)(2)
						(Register 2016, No. 13).
4. Amendment filed 11-6-2018; operative
						1-1-2019. Submitted to OAL for filing and printing only pursuant to Government
						Code section
						11340.9(g)
						(Register 2018, No. 45).
Note: Authority: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  5307.1 and
						  5307.11, Labor
						  Code.