California's New Medical-legal Fee Schedule
| Jurisdiction | California,United States |
| Author | The Hon. Robert G. Rassp |
| Publication year | 2021 |
| Citation | Vol. 34 No. 2 |
The Hon. Robert G. Rassp
Los Angeles, California
Disclaimer: The opinions expressed in this article are the opinions of the author and are not the opinions of The State of California Department of Industrial Relations, Division of Workers' Compensation, or the Workers' Compensation Appeals Board.
The California Office of Administrative Law approved the new medical-legal fee schedule for workers' compensation cases on March 30, 2021. This article summarizes the new fee schedule and provides some commentary on the potential consequences of the new regulations and how they might affect the practice of workers' compensation law and medical-legal evaluations. The new regulations are in 8 CCR sections 9793 through 9795. Section 9793 has definitions; section 9794 provides the mandate for reimbursement for medical-legal examination and reports, including the payment and collection procedures and IBR requirements; and section 9795 is the actual fee schedule.
Pursuant to 8 CCR section 9795(f), the medical-legal fee schedule became effective for a physical examination or medical-legal testimony that occurs on or after April 1, 2021. Notice that the effective date of the fee schedule is not the date a medical-legal physician issues a report. For supplemental reports, the fee schedule applies if the request for a supplemental report occurs on or after April 1, 2021. Supplemental reports do not require a physical examination and usually involve a request by a party for the medical-legal physician to clarify their conclusions in a prior report or to answer questions that were originally asked but not addressed in the prior reporting.
The prior medical-legal fee schedule based billing on time spent and complexity factors, identified by codes such as ML101, ML104, ML106. The new schedule establishes a flat fee for different types of reporting involving fewer than 200 pages of review by the reporting physician. In addition, there is a $3.00 per page charge for review of records that are greater than 200 pages, provided the evaluating physician did not previously review those records. There is an increase in payment rates for medical-legal testimony and reports by psychiatrists, psychologists, and internal medicine physicians who review cases where the claim is primarily involving toxicology or oncology. There is a new declaration under penalty of perjury that parties have to sign certifying the number of pages being requested for the physician to review. Physicians have to indicate under penalty of perjury how many pages of documents they reviewed. There is also a flat fee for missed appointments.
Following are more specific aspects of the new medical-legal report billing schedule.
- Includes an initial evaluation.
- Includes a follow-up evaluation that is 18 months and one day later than the last evaluation.
- $2,015.00 plus $3.00 per page of review in excess of 200 pages.
- An evaluation that occurs within 18 months of a prior comprehensive evaluation.
- Records previously reviewed are excluded from payment.
- $1,316.25 plus $3.00 per page in excess of 200 pages of records not previously reviewed.
- Refers only to a request for a supplemental report if the physician failed to address an issue previously requested or a new development occurs.
- $650.00 plus $3.00 per page after 50 pages. This refers to 50 pages and any additional pages that were not previously reviewed.
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