Last month in this space, we covered reimbursement for the DWC Form PR-2, or the primary treating physician’s progress report. Since that time, we’ve received a number of questions from clients about reimbursement (or the lack thereof) for other various required reports. Unlike most workers’ comp subjects, this one is actually pretty straightforward.

Here’s a representative support ticket submitted to our team:

“A few people have asked me about secondary treating physicians and how they are compensated for reports. It’s my understanding that only the primary treating physician is compensated for reports. Is that right? If not, could you point me towards the regulations?”

Two main points on this.

First, our client is correct. Secondary treating physicians are not reimbursed for their reports.

Second, the Physician Fee Schedule regulations, along with the California Code of Regulations, lay down explicit instructions regarding reimbursable and non-reimbursable reports. From § 9789.14 of the CCR (emphasis ours):

“The following treatment reports are not separately reimbursable as the appropriate fee is included within the underlying Evaluation and Management service, Physical Therapy Evaluation service or Occupational Therapy Evaluation service for an office visit:
(1) Doctor's First Report of Occupational Illness or Injury (Form 5021) issued in accordance with section 9785(e). Use Code WC001;
(2) Consultation Reports, except as specified in subdivision (b)(5).^[1] 
(3) Report by a secondary physician to the primary treating physician.
(4) Physician’s Return-to-Work & Voucher Report (DWC-AD 10133.36) issued in accordance with section 9785 subdivision (i) (reimbursement is bundled into payment for PR-3 or PR-4).”^[2]

What about those reports that are reimbursable? That’s easy, too – just think of the California-Specific procedure codes:

Just remember – consultation reports and psychiatric reports are only reimbursable if requested by the WCAB or the DWC administrative director.

Have questions? Feel free to get in touch – you may even be featured in a future post.

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