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 9789.32 - Outpatient Hospital Departments and Ambulatory Surgical Centers Fee Schedule - Applicability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Sections
					 9789.30 through
					 9789.39 shall be applicable to the
					 maximum allowable fees for emergency room visits and surgical procedures
					 provided on an outpatient basis rendered on or after July 1, 2004, but before
					 September 1, 2014. Sections
					 9789.30 through
					 9789.39 shall be applicable to the
					 maximum allowable fees for emergency room visits, surgical procedures, and
					 Facility Only Services provided on an outpatient basis rendered on or after
					 September 1, 2014, but before December 15, 2016. Sections
					 9789.30 through
					 9789.39 shall be applicable to the
					 maximum allowable fees for services provided on an outpatient basis and payable
					 under the Medicare (CMS) HOPPS rendered on or after December 15, 2016. For
					 purposes of this section, emergency room visits and surgical procedures shall
					 be defined by HCPCS codes set forth in section
					 9789.39(b) by date
					 of service. A supply, drug, device, blood product and biological is considered
					 an integral part of an emergency room visit, or surgical procedure, or, if
					 applicable, Facility Only Service, or if applicable and only if rendered on or
					 after December 15, 2016, Other Service if:
(1)
Date of
								Service
Supply, Drug, Device, Blood
								Product, or Biological
For services rendered before March 1,
								2008
The item has a status code N and is packaged into the APC payment
								for the emergency room visit or surgical procedure (in which case no additional
								fee is allowable).
For services rendered on or after March 1, 2008 but
								before March 1, 2009
The item has a status code N or Q and is packaged
								into the APC payment for the emergency room visit or surgical procedure (in
								which case no additional fee is allowable).
For services rendered on or after March 1, 2009 but
								before September 1, 2014
The item has a status code N, Q1, Q2, or Q3
								and is packaged into the APC payment for the emergency room visit or surgical
								procedure (in which case no additional fee is allowable).
For services rendered on or after September 1, 2014
								but before December 15, 2016
The item has a status code N, Q1, Q2, or
								Q3 and is packaged into the APC payment for the emergency room visit, surgical
								procedure, or Facility Only Service (in which case no additional fee is
								allowable).
For services rendered on or after December 15,
								2016
The item has a status code N, Q1, Q2, or Q3 and is packaged into
								the APC payment for the emergency room visit, surgical procedure, or Other
								Service (in which case no additional fee is allowable).
(2)
Date of
								Service
Supply, Drug, Device, Blood
								Product, or Biological
For services rendered before March 1,
								2009
The item is furnished in conjunction with an emergency room visit
								or surgical procedure and has been assigned Status Code G, H or K.
For services rendered on or after March 1, 2009 but
								before September 1, 2014
The item is furnished in conjunction with an
								emergency room visit or surgical procedure and has been assigned status code G,
								H, K, R, or U.
For services rendered on or after September 1, 2014
								but before December 15, 2016
The item is furnished in conjunction with
								an emergency room visit, surgical procedure, or Facility Only Service, and has
								been assigned status code G, H, K, R, or U.
For services rendered on or after December 15,
								2016
The item is furnished in conjunction with an emergency room visit,
								surgical procedure, or Other Service and has been assigned status code G, H, K,
								R, or U.