1. (a) The conversion factors to be used for determining maximum reasonable fees are set forth in section 9789.19, by date of service.

2. (b) (1) Commencing January 1, 2014, there shall be a four-year transition between:

   1. (2) During the transition, the conversion factors before adjustment shall be as follows:

      Type of Service

      OMFS Budget- Neutral CF

      120% 2012 Medicare

      2014 (75 Percent OMFS/25 Percent 120 % Medicare)

      2015 (50 Percent OMFS/50 Percent 120 % Medicare)

      2016 (25 Percent OMFS/75 Percent 120 % Medicare)

      2017 (120% Medicare)

      Anesthesia

      34.5903

      25.6896

      32.3651

      30.1400

      27.9148

      25.6896

      Surgery

      55.6849

      40.8451

      51.9750

      48.2650

      44.5551

      40.8451

      Radiology

      52.9434

      40.8451

      49.9188

      46.8943

      43.8697

      40.8451

      All other services

      34.4566

      40.8451

      36.0537

      37.6509

      39.2480

      40.8451

   2. (3) The conversion factors specified in subdivision (b)(2) shall be adjusted by the cumulative changes in MEI and the Relative Value Scale Adjustment Factor, if any, between 2012 and each transition year. See section 9789.19 for annual and cumulative MEI, and Relative Value Scale Adjustment Factor, by date of service.

      1. (1) The anesthesia conversion factor shall be applied to CPT codes in the Anesthesia section of the CPT;
      2. (2) The surgery conversion factor shall be applied to CPT codes in the Surgery section of the CPT;
      3. (3) The radiology conversion factor shall be applied to CPT codes in the Radiology section of the CPT;
      4. (4) The “other services” conversion factor shall be applied to CPT codes in the Evaluation and Management, Medicine, and Pathology and Laboratory sections of the CPT, to the extent the services are payable under this fee schedule.
      5. (B) In 2017, and thereafter, there will be two conversion factors: Anesthesia and Other Services.

      (4)(A) During years 2014 through 2016:

   “OMFS Budget Neutral CF”: the estimated aggregate maximum allowable amount under the official medical fee schedule for physician services prior to January 1, 2014, and

   “120% RBRVS 2012 CF”: the maximum allowable amount based on the resource-based relative value scale at 120 percent of the Medicare conversion factor in effect in July 2012.

3. (c) For calendar year 2018, and annually thereafter, the Anesthesia conversion factor and the Other Services conversion factor in effect in the prior calendar year shall be updated by the Medicare Economic Index inflation rate and by the Relative Value Scale Adjustment Factor, if any.

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.

History

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. Editorial correction of subsection (b)(2) (Register 2015, No. 12).