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

§9789.40.4. Compounding Fee and Sterility Fee for Pharmacy Dispensed or Physician Dispensed Compounded Drugs: Route of Administration Compounding Fee/Sterility Fee Table; Dosage Form Compounding Fee Table; Compounded Drugs Dispensed on or after July 1, 2025.

The maximum allowable compounding fee, sterility fee, and professional dispensing fee payable to a pharmacy pursuant to section 9789.40.3 or to a physician for purposes of section 9789.40.7, subdivision (a)(2), shall be determined as follows.

(a) The Compounding Fee per allowed container is the lower of the billed compounding fee amount or:

(1) the fee designated for the compounded drug's route of administration on the Route of Administration Compounding Fee/Sterility Fee Table set forth in subdivision (e), or, if that amount is zero,

(2) the fee designated for the compounded drug's applicable dosage form and range of dosage metric decimal units on the Dosage Form Compounding Fee Table set forth in subdivision (f).

(b) The Sterility Fee per allowed container is the lower of the billed sterility fee amount or the fee designated in the Route of Administration Compounding/Sterility Fee Table set forth in subdivision (e). A Sterility Fee is allowed only when sterility testing is performed by the pharmacy or physician. The pharmacy or physician must maintain records of the sterility testing with the prescription.

(c) The maximum professional dispensing fee per allowed container is the dispensing fee determined pursuant to section 9789.40.3 for a pharmacy or $10.05 for a physician dispensing in accordance with Business and Professions Code section 4170.

(d) Allowed container count:

(1) The maximum billable container count per dispensed compounded prescription equals one.

(2) Notwithstanding paragraph one, up to 20 containers may be billed for the following Compound Route of Administration Descriptions:

(A) Injection

(B) Infusion.

(e) Route of Administration Compounding Fee/Sterility Fee Table

Compound Route of Administration Description	Metric Decimal Quantity Range	Compounding Fee	Sterility Fee
Buccal	000 to 9999999	0	0
Dental	000 to 9999999	0	0
Enteral	000 to 9999999	0	0
Infusion	000 to 9999999	0.99	0.32
Inhalation	000 to 9999999	0	0
Injection	000 to 9999999	0.99	0.32
Intraperitoneal	000 to 9999999	0	0.32
Irrigation	000 to 9999999	0	0.32
Mouth/Throat	000 to 9999999	0	0
Mucous Membrane	000 to 9999999	0	0.32
Nasal	000 to 9999999	0.81	0
Ophthalmic	000 to 9999999	2.04	0.32
Oral	000 to 9999999	0	0
Other/Miscellaneous	000 to 9999999	0	0
Otic	000 to 9999999	0.81	0
Rectal	000 to 9999999	0	0
Sublingual	000 to 9999999	0	0
Topical	000 to 9999999	0	0
Transdermal	000 to 9999999	0	0
Translingual	000 to 9999999	0	0
Urethral	000 to 9999999	0	0.32
Vaginal	000 to 9999999	0	0

(f) Dosage Form Compounding Fee Table

Compound Dosage Form	Compound Dosage Form Description	Compound Claim Quantity Low Range	Compound Claim Quantity High Range	Compounding Fee
01	Capsule	0000000	0000005	0.00
01	Capsule	0000006	0000036	1.98
01	Capsule	0000037	9999999	3.95
02	Ointment	0000001	0000179	1.64
02	Ointment	0000180	9999999	3.29
03	Cream	0000001	0000179	1.64
03	Cream	0000180	9999999	3.29
04	Suppository	0000001	0000023	3.29
04	Suppository	0000024	9999999	5.76
05	Powder	0000000	0000005	0.00
05	Powder	0000006	0000036	1.98
05	Powder	0000037	9999999	3.95
06	Emulsion	0000001	0000239	0.81
06	Emulsion	0000240	9999999	1.64
07	Liquid	0000000	9999999	0.99
10	Tablet	0000000	0000005	0.00
10	Tablet	000006	0000036	1.98
10	Tablet	0000037	9999999	3.95
11	Solution	0000000	9999999	0.99
12	Suspension	0000000	9999999	0.99
13	Lotion	0000001	0000239	0.81
13	Lotion	0000240	9999999	1.64
14	Shampoo	0000000	9999999	0.99
15	Elixir	0000000	9999999	0.99
16	Syrup	0000000	9999999	0.99
17	Lozenge	0000000	0000005	0.00
17	Lozenge	0000006	0000036	1.98
17	Lozenge	0000037	9999999	3.95
18	Enema	0000000	9999999	0.99

Credits

Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.

History

1. New section filed 12-11-2024; operative 7-1-2025. Submitted to OAL for filing and printing only pursuant to Government Code section 1340.9(g) (Register 2024, No. 50).