Article 5.3. Official Medical Fee Schedule | MidpageArticle 5.3. Official Medical Fee Schedule
State of California
9789.10Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014 -- Definitions.9789.11Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014.9789.12.1Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services -- For Services Rendered On or After January 1, 2014.9789.12.2Calculation of the Maximum Reasonable Fee -- Services Other than Anesthesia.9789.12.3Status Codes C, I, N and R.9789.12.4“By Report” -- Reimbursement for Unlisted Procedures/Procedures Lacking RBRVUs.9789.12.5Conversion Factors.9789.12.6Geographic Health Professional Shortage Area Bonus Payment: Primary Care; Mental Health.9789.12.7CMS' National Physician Fee Schedule Relative Value File / Relative Value Units (RVUs).9789.12.8Status Codes.9789.12.9Professional Component (PC)/Technical Component (TC) Indicator.9789.12.10Coding; Current Procedural Terminology, Fourth Edition.9789.12.11Evaluation and Management: Coding -- New Patient; Established Patient; Documentation.9789.12.12Consultation Services Coding -- Use of Visit Codes.9789.12.13Correct Coding Initiative.9789.12.14California Specific Codes.9789.12.15California Specific Modifier.9789.13.1Supplies.9789.13.2Physician-Administered Drugs, Biologicals, Vaccines, Blood Products.9789.13.3Physician-Dispensed Drugs.9789.14Reimbursement for Reports, Duplicate Reports, Chart Notes.9789.15.1Non-Physician Practitioner (NPP) -- Payment Methodology.9789.15.2Non-Physician Practitioner (NPP) -- “Incident To” Services.9789.15.3Qualified Non-Physician Anesthetist Services.9789.15.4Physical Medicine/Chiropractic/Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure/Modality Services.9789.15.5Ophthalmology Multiple Procedure Reduction.9789.15.6Diagnostic Cardiovascular Procedures -- Multiple Procedure Reduction.9789.16.1Surgery -- Global Fee.9789.16.2Surgery -- Billing Requirements for Global Surgeries.9789.16.3Surgery -- Global Fee -- Miscellaneous Rules.9789.16.4Surgery -- Global Fee; Exception: Circumstances Allowing E&M Code During the Global Period; Primary Treating Physician's Progress Report (PR-2).9789.16.5Surgery -- Multiple Surgeries and Endoscopies.9789.16.6Surgery -- Bilateral Surgeries.9789.16.7Surgery -- Co-Surgeons and Team Surgeons.9789.16.8Surgery -- Assistants-at-Surgery.9789.17.1Radiology Diagnostic Imaging Multiple Procedures.9789.17.2Radiology Consultations.9789.17.3Additional Payment Reductions for Certain Diagnostic Imaging Services.9789.18.1Payment for Anesthesia Services -- General Payment Rule.9789.18.2Anesthesia -- Personally Performed Rate.9789.18.3Anesthesia -- Medically Directed Rate.9789.18.4Anesthesia -- Definition of Concurrent Medically Directed Anesthesia Procedures.9789.18.5Anesthesia -- Medically Supervised Rate.9789.18.6Anesthesia -- Multiple Anesthesia Procedures.9789.18.7Anesthesia -- Medical and Surgical Services Furnished in Addition to Anesthesia Procedure.9789.18.8Anesthesia -- Time and Calculation of Anesthesia Time Units.9789.18.9Anesthesia -- Base Unit Reduction for Concurrent Medically Directed Procedures.9789.18.10Anesthesia -- Monitored Anesthesia Care.9789.18.11Anesthesia Claims Modifiers.9789.18.12Anesthesia and Medical/Surgical Service Provided by the Same Physician.9789.19Update Table.9789.19.1Table A.9789.20General Information for Inpatient Hospital Fee Schedule -- Discharge on or After July 1, 2004.9789.21Definitions for Inpatient Hospital Fee Schedule.9789.22Payment of Inpatient Hospital Services.9789.23Hospital Cost to Charge Ratios, Hospital Specific Outliers, and Hospital Composite Factors.9789.24Diagnostic Related Groups, Relative Weights, Geometric Mean Length of Stay.9789.25Federal Regulations, Federal Register Notices, and Payment Impact File by Date of Discharge.9789.30Hospital Outpatient Departments and Ambulatory Surgical Centers -- Definitions.9789.31Hospital Outpatient Departments and Ambulatory Surgical Centers--Adoption of Standards.9789.32Outpatient Hospital Departments and Ambulatory Surgical Centers Fee Schedule -- Applicability.9789.33Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule -- Determination of Maximum Reasonable Fee.9789.34Table A.9789.35Table B.9789.36Update of Rules to Reflect Changes in the Medicare Payment System.9789.37DWC Form 15 Election for High Cost Outlier.9789.38Appendix X.9789.39Update Table by Date of Service.9789.40Pharmacy -- Pharmaceuticals Dispensed and Pharmaceutical Services Rendered Prior to July 1, 2025.9789.40.1Pharmaceutical Fee Data File for Pharmacy and Physician Dispensed Pharmaceuticals; National Provider Identifier File for Pharmacy Dispensed Pharmaceuticals; for Products Dispensed and Services Rendered on or after July 1, 2025.9789.40.2Pharmaceuticals Dispensed and Pharmaceutical Services Rendered By a Pharmacy on or after July 1, 2025.9789.40.3Compounded Pharmaceuticals Dispensed By a Pharmacy on or after July 1, 2025.9789.40.4Compounding Fee and Sterility Fee for Pharmacy Dispensed or Physician Dispensed Compounded Drugs: Route of Administration Compounding Fee/Sterility Fee Table; Dosage Form Compounding Fee Table; Compounded Drugs Dispensed on or after July 1, 2025.9789.40.5Miscellaneous Provisions -- Pharmaceuticals Dispensed By a Pharmacy on or after July 1, 2025.9789.40.6Pharmaceuticals Dispensed By a Physician on or after July 1, 2025.9789.40.7Compounded Pharmaceuticals Dispensed By a Physician on or after July 1, 2025.9789.50Pathology and Laboratory.9789.60Durable Medical Equipment, Prosthetics, Orthotics, Supplies.9789.70Ambulance Services.9789.80Skilled Nursing Facility. [Reserved]9789.90Home Health Care. [Reserved]9789.100Outpatient Renal Dialysis. [Reserved]9789.110Update of Rules to Reflect Changes in the Medicare Payment System.9789.111Effective Date of Fee Schedule Provisions.