omfs: physician fee schedule calculation physician fee schedule calculation.pdf© daisybill 2017...
Post on 31-Jan-2021
0 Views
Preview:
TRANSCRIPT
-
© 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)
✖
✖
✖
=
=
=
top related