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 5.5 - Application of the Official Medical Fee Schedule (Treatment) › Section 9792 - Determination of the Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The fee is determined by the use of the Official Medical Fee Schedule as
					 defined in Section
					 9791.1 of these rules. For services
					 provided on and after January 1, 1994, the conversion factors to be applied to
					 unit values in the schedule are as follows:
Determination of the
								  Fee
Evaluation and Management Services
								Section..........................
..........................$7.15
Medicine
								Section..........................
..........................$6.15
Surgery
								Section..........................
..........................$153.00
Radiology
								Section..........................
..........................$12.50
Pathology
								Section..........................
..........................$1.50
Anesthesia
								Section..........................
..........................$34.50
(b) For services in the Evaluation and
					 Management Services Section provided on and after April 1, 1999, the conversion
					 factor to be applied to unit values in the schedule is $8.50.
(c) The conversion factor shall be multiplied
					 by the listed unit value (also known as relative value) of the procedure as set
					 forth in the Official Medical Fee Schedule to establish the reasonable maximum
					 fee. A medical provider or a licensed health care facility may be paid a fee in
					 excess of the reasonable maximum fees if the fee is reasonable, accompanied by
					 itemization, and justified by an explanation of extraordinary circumstances
					 related to the unusual nature of the services rendered; however, in no event
					 shall a physician charge in excess of his or her usual fee.
1.
						Amendment filed 4-11-79; designated effective 7-1-79 (Register 79, No.
						15).
2. Amendment filed 8-14-81; effective thirtieth day thereafter
						(Register 81, No. 33).
3. Amendment filed 11-5-82; designated
						effective 1-1-83 (Register 82, No. 45).
4. Amendment filed 11-23-83;
						effective thirtieth day thereafter (Register 83, No. 48).
5.
						Amendment filed 8-29-84; effective thirtieth day thereafter (Register 84, No.
						35).
6. Editorial correction (Register 84, No. 48).
7.
						Amendment filed 1-10-85; effective upon filing pursuant to Government Code
						section
						11346.2(d)
						(Register 85, No. 2).
8. Amendment filed 7-1-87; operative 7-1-87
						(Register 87, No. 28).
9. Amendment of section and NOTE filed
						10-7-93; operative 1-1-94 (Register 93, No. 41). This filing is exempt from
						much of the APA (including OAL review) pursuant to Government Code section
						11351.
10.
						New subsection (a) designator, new subsection (b), and amendment of newly
						designated subsection (c) filed 2-19-99; operative 4-1-99 (Register 99, No.
						8).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4603.2 and
						  5307.1, Labor
						  Code.