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 9789.10 - Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Basic value" means the unit value for an
					 anesthesia procedure that is set forth in the Official Medical Fee Schedule
					 2003.
(b) "CMS" means the Centers
					 for Medicare & Medicaid Services of the United States Department of Health
					 and Human Services.
(c) "Conversion
					 factor" or "CF" means the factor set forth below for the applicable OMFS
					 section:
Evaluation and
								Management
$8.50
Medicine
$6.15
Surgery
$153.00
Radiology
$12.50
Pathology
$1.50
Anesthesia
$34.50
(d) "CPT®"
					 means the procedure codes set forth in the American Medical Association's
Physicians' Current Procedural Terminology (CPT) 1997
,
					 copyright 1996, American Medical Association, or the
Physicians'
					 Current Procedural Terminology (CPT) 1994
, copyright 1993, American
					 Medical Association.
(e) "Medicare
					 rate" means the physician fee schedule rate derived from the Resource Based
					 Relative Value Scale and related data, adopted for the Calendar Year 2004,
					 published in the Federal Register on January 7, 2004, Volume 69, No. 4, pages
					 1117 through 1242 (CMS-1372-IFC), as amended by CMS Manual System,
					 Pub.
					 100-04 Medicare Claims Processing, Transmittal 105
					 (February 20, 2004). The Medicare rate for each procedure is derived by the
					 Administrative Director utilizing the non-facility rate (or facility rate if no
					 non-facility rate exists), and a weighted average geographic adjustment factor
					 of 1.063.
(f) "Modifying units"
					 means the anesthesia modifiers and qualifying circumstances as set forth in the
					 Official Medical Fee Schedule 2003.
(g) "Official Medical Fee Schedule" or "OMFS"
					 means Article 5.3 of Subchapter 1 of Chapter 4.5 of Title 8, California Code of
					 Regulations (Sections
					 9789.10 -
					 9789.111), adopted pursuant to
					 Section
					 5307.1 of the
					 Labor Code for all medical services, goods, and treatment provided pursuant to
					 Labor Code Section
					 4600.
(h) "Official Medical Fee Schedule 2003" or
					 "OMFS 2003" means the Official Medical Fee Schedule incorporated into Section
					 9791.1 in effect on December 31,
					 2003, which consists of the OMFS book revised April 1, 1999 and as amended for
					 dates of service on or after July 12, 2002.
(i) "Percentage reduction calculation" means
					 the factor set forth in Table A for each procedure code which will result in a
					 reduction of the OMFS 2003 rate by 5%, or a lesser percent so that the
					 reduction results in a rate that is no lower than the Medicare rate.
(j) "Physician service" means professional
					 medical service that can be provided by a physician, as defined in Section
					 3209.3 of the
					 Labor Code, and is subject to reimbursement under the Official Medical Fee
					 Schedule. For purposes of the OMFS, "physician service" includes service
					 rendered by a physician or by a non-physician who is acting under the
					 supervision, instruction, referral or prescription of a physician, including
					 but not limited to a physician assistant, nurse practitioner, clinical nurse
					 specialist, and physical therapist.
(k) "RVU" means the relative value unit for a
					 particular procedure that is set forth in the Official Medical Fee Schedule
					 2003.
(l) "Time value" means the
					 unit of time indicating the duration of an anesthesia procedure that is set
					 forth in the Official Medical Fee Schedule 2003.
1. New
						article 5.3 (sections
						9789.10-9789.110) and 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 article heading, new introductory paragraph and amendment of
						subsections (d), (e) and (g), transmitted to OAL 4-30-2004 and filed 6-15-2004
						(Register 2004, No. 25).
3. Amendment of section heading filed
						2-4-2015; operative 3-5-2015. Submitted to OAL for printing only pursuant to
						Government Code section
						11340.9
						(Register 2015, No. 6).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4603.2 and
						  5307.1, Labor
						  Code.