OMFS: Physician Fee Schedule Calculation Physician Fee Schedule Calculation.pdf© DaisyBill 2017...

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© DaisyBill 2017 Workers’ Compensation Resources CCR § 9789.12.2 Calculation of the Maximum Reasonable Fee - Services Other than Anesthesia OMFS: Physician Fee Schedule Calculation 1. Determine which formula to use based on place of service. ● Non-Facility or Facility 2. Look up three Relative Value Units (RVUs)* assigned to procedure code. ● Usually change every quarter 3. Determine the three statewide Geographic Adjustment Factors (GAFs)*. ● Three GAFs correspond to three RVUs ● Usually change annually 4. Determine Conversion Factor values*. ● Anesthesia or Other Services ● Usually change annually 5. Calculate using the correct formula and plugging in the appropriate RVUs, GAFs, and Conversion Factors. * Found in CCR § 9789.19 Update Table

Transcript of OMFS: Physician Fee Schedule Calculation Physician Fee Schedule Calculation.pdf© DaisyBill 2017...

  • © DaisyBill 2017 Workers’ Compensation Resources

    CCR § 9789.12.2 Calculation of the Maximum Reasonable Fee - Services Other than Anesthesia

    OMFS: Physician Fee Schedule Calculation

    1. Determine which formula to use based on place of service.● Non-Facility or Facility

    2. Look up three Relative Value Units (RVUs)* assigned to procedure code.● Usually change every quarter

    3. Determine the three statewide Geographic Adjustment Factors (GAFs)*.● Three GAFs correspond to three RVUs● Usually change annually

    4. Determine Conversion Factor values*.● Anesthesia or Other Services● Usually change annually

    5. Calculate using the correct formula and plugging in the appropriate RVUs, GAFs, and Conversion Factors.

    * Found in CCR § 9789.19 Update Table

  • © DaisyBill 2017 Workers’ Compensation Resources

    (b) Facility site of service base [(Work RVU ✖ Statewide Work GAF) + (Facility PE RVU ✖ Statewide PE GAF) + (MP RVU * Statewide MP GAF)] ✖ Conversion Factor (CF)

    (a) Non-facility site of service [(Work RVU ✖ Statewide Work GAF) + (Non-Facility PE RVU ✖ Statewide PE GAF) + (MP RVU * Statewide MP GAF)] ✖ Conversion Factor (CF)

    CCR § 9789.12.2 Calculation of the Maximum Reasonable Fee - Services Other than Anesthesia

    Key: RVU = Relative Value Unit GAF = Average Statewide Geographic Adjustment Factor Work = Physician Work PE = Practice Expense MP = Malpractice Expense

    OMFS: Physician Fee Schedule Base Maximum Fee Formulas

  • © DaisyBill 2017 Workers’ Compensation Resources

    OMFS: Physician Fee Schedule - Sample Calculation

    Procedure Code: 99214 Place of Service: Non-FacilityService: Other (Non-anesthesia)Formula: [(Work RVU ✖ Statewide Work GAF) +

    (Non-Facility PE RVU ✖ Statewide PE GAF) + (MP RVU * Statewide MP GAF)] ✖ Conversion Factor (CF)

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