Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director -Administrative Rules
Article 5.3. Official Medical Fee Schedule

§9789.17.3. Additional Payment Reductions for Certain Diagnostic Imaging Services.

(a) For services rendered on or after March 1, 2017, payment of X-ray imaging services that are taken using film is made at:

(1) 80 percent of a technical component-only service;

(2) 80 percent of the technical component of a global service.

Services for X-rays using film must be identified through the use of modifier “FX.” For services subject to both the multiple procedure payment reduction (MPPR) set forth in section 9789.17.1, and the “FX” modifier reduction on imaging, the “FX” modifier reduction should be applied before the MPPR for radiology diagnostic imaging procedures.

(b) For services rendered on or after January 1, 2018, payment for imaging services that are X-rays taken using computed radiography is made at:

(1) 93 percent of a technical component-only service;

(2) 93 percent of the technical component of a global service.

Imaging services that are X-rays taken using computed radiography must be identified through the use of the modifier “FY.” For services subject to both the multiple procedure payment reduction (MPPR) set forth in section 9789.17.1, and the “FY” modifier reduction on imaging, the “FY” modifier reduction should be applied before the MPPR for radiology diagnostic imaging procedures. Computed radiography technology is defined for purposes of this subdivision as cassette-based imaging which utilizes an imaging plate to create the image involved.

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 7-18-2017; operative 3-1-2017. Submitted to OAL as a file and print only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 29).

2. Designation of first paragraph as subsection (a) and new subsection (b) filed 12-28-2017; operative 1-1-2018. Submitted to OAL for filing and printing only pursuant to Labor Code section 5307-1(g)(2) (Register 2017, No. 52).