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Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of...
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![Page 1: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/1.jpg)
Medical Fee Schedule Overview
Suzanne Honor-Vangerov
Workers’ Compensation Manager
Division of Workers’ Compensation
Medical Unit
![Page 2: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/2.jpg)
The Present – Post 1/12004
• 1999 Official Medical Fee Schedule – All Physician’s Services
• Evaluation and Management• Anesthesia• Surgery• Radiology- all service locations• Medicine• Physical Medicine• Special Services
![Page 3: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/3.jpg)
Medicare Based Fee Schedules120% of Medicare Rates
• Clinical Laboratory – updated annually• DME – updated quarterly
– All suppliers: wholesale, retail, mail-order, provider
• Orthotics, Prosthetics and Supplies – updated quarterly• Inpatient Facility – updated annually• Outpatient Facility – OPPS Schedule – updated annually
– Hospital Outpatient Departments– Ambulatory Surgery Centers
• Ambulance – updated annually
![Page 4: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/4.jpg)
Pharmacy Services
• Medi-Cal Based Fee Schedule– 100% of Medi-Cal’s rates– Applies to anyone dispensing pharmaceuticals– Web based calculator– Database updated first day of each week.– Doesn’t include repackaged drugs
• Drugs not found in Medi-Cal’s database paid based on rates in effect December 31, 2003
![Page 5: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/5.jpg)
Upcoming Fee Schedules
• Fee Schedules due in 2006– Updated Medical-Legal Fee schedule– Repackaged Pharmaceuticals– New Physician’s fee schedule
• Based on RBRVS
![Page 6: Medical Fee Schedule Overview Suzanne Honor-Vangerov Workers’ Compensation Manager Division of Workers’ Compensation Medical Unit.](https://reader036.fdocuments.in/reader036/viewer/2022082709/56649d9c5503460f94a84a40/html5/thumbnails/6.jpg)
Where Are They Found?
• 1999 Official Medical Fee Schedule
• DWC’s web site www.dir.ca.gov/dwc
• Medicare’s web site www.cms.hhs.gov
• Medi-Cal’s web site www.medi-cal.ca.gov