Cal. Code Regs. tit. 8, § 9789.32
(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.
(c) This subsection (c) is inapplicable for dates of services on or after December 15, 2016. Depending on date of service, the maximum allowable fees for services, drugs and supplies furnished by hospitals that do not meet the requirements in (a) for a facility fee payment and are not bundled in the APC payment rate for services in (a) will be determined as follows:
(B) For Other Services rendered on or after September 1, 2014, but before December 15, 2016, to hospital outpatients, the maximum allowable hospital outpatient facility fees shall be paid according to the OMFS RBRVS.
(ii) For Other Services, which do not meet the requirement in (i), the hospital outpatient facility fee shall be determined based solely on the non-facility practice expense relative value units applicable under the OMFS RBRVS.
The base facility fee is calculated as follows: Non-Facility Site of Service Practice Expense (PE) Relative Value Unit (RVU) * Statewide Geographic Adjustment Factor (GAF) for PE * RBRVS Conversion Factor (CF) = Base facility fee.
(1)(A) For services rendered before September 1, 2014, the maximum allowable hospital outpatient facility fees for professional medical services which are performed by physicians and other licensed health care providers to hospital outpatients shall be paid according to Section 9789.10 and Section 9789.11.
(d) Hospital Outpatient Departments and ASCs should utilize other applicable parts of the OMFS to determine maximum allowable fees for services or goods not covered by the Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule (Sections 9789.30 through 9789.39).
(e) For services rendered before September 1, 2014, only hospitals may charge or collect a facility fee for emergency room visits. Only hospital outpatient departments and ambulatory surgical centers as defined in Section 9789.30(p) and Section 9789.30(c) may charge or collect a facility fee for surgical services provided on an outpatient basis.
For services rendered on or after September 1, 2014, but before December 15, 2016, only hospitals may charge or collect a facility fee for emergency room visits, Facility Only Services, and Other Services. Only hospital outpatient departments and ambulatory surgical centers as defined in Section 9789.30(p) and Section 9789.30(c) may charge or collect a facility fee for surgical services provided on an outpatient basis. Facility fees are not payable to an ambulatory surgical center for any services that are not an integral part of a surgical service.
For services rendered on or after December 15, 2016, only hospitals as defined in Section 9789.30(p) may charge or collect a facility fee for Hospital Outpatient Department Services rendered to a hospital outpatient and payable under the Medicare (CMS) HOPPS. Ambulatory surgical centers as defined in Section 9789.30(c) may charge or collect a facility fee for only surgical services or services that are an integral part of the surgical service provided on an outpatient basis and payable under the Medicare (CMS) HOPPS. Facility fees are not payable to an ambulatory surgical center for any services that are not an integral part of a surgical service. Only ambulatory surgical centers may charge or collect a facility fee for its services.
Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.
1. New 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 section, transmitted to OAL 4-30-2004 and filed 6-15-2004 (Register 2004, No. 25).
3. Amendment of subsections (a), (b), (c)(3), (e) and (h) filed 12-27-2012; operative 1-1-2013 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2012, No. 52).
4. Amendment filed 6-3-2014; operative 9-1-2014 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2014, No. 23).
5. Amendment of subsection (c)(1)(B)(ii) filed 9-23-2014; operative 9-1-2014 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2014, No. 39).
6. Amendment of section heading and section filed 12-15-2016; operative 12-15-2016 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2016, No. 51).
7. Amendment of subsection (a)(1) filed 5-8-2018; operative 3-15-2018 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2018, No. 19).