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Bill would require Calif. fee schedule reviews twice a year

medical fees

The California Division of Workers’ Compensation would be required to review the Medical-Legal Fee Schedule at least twice a year and increase payments based on the percentage change in the Medicare Economic Index, under a recently amended bill.

A.B. 404 was amended Tuesday to add language that would appear to require the DWC to review and adjust the MLFS at least every six months.

The amended bill would require the administrative director to “biannually review, and if necessary, update the schedule to reflect the rising costs of maintaining a medical practice by increasing the conversion factor and the per-page cost of reviewing records based on the percentage increase in the most current federal Medicare Economic Index.”

As introduced, the bill would have required the DWC to review and update the fee schedule annually.

The Division of Workers' Compensation adopted a new Medical-Legal Fee Schedule that took effect April 1. The new fee schedule pays $2,015 for a comprehensive medical-legal exam and $1,316.25 for a follow-up exam. The flat rate covers the first 200 pages of record review, with reimbursement at $3 per page after that.

The new fee schedule also authorizes payment for missed appointments and includes modifiers that increase reimbursement rates for exams by psychiatrists and psychologists, or when toxicology or oncology are the primary focus of the evaluation.

WorkCompCentral is a sister publication of Business Insurance. More stories here.