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Reminder: Secondary Treating Physician Reports Not Payable

August 9, 2017 by Catherine Montgomery

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:

Code

Description

2017 Reimbursement

WC002

Treating Physician's Progress Report (Form PR-2)

$12.29

WC003

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): First page

$39.89

 

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): Each additional page. Maximum of six pages absent mutual agreement.

$24.54

WC004

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): First page

$39.89

 

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): Each additional page. Maximum of seven pages absent mutual agreement.

$24.54

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: First page

$39.89

 

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: Each additional page. Maximum of six pages absent mutual agreement

$24.54

WC007

Consultation Reports Requested by the Workers' Compensation Appeals Board or the Administrative Director: First page

$39.89

 

Consultation Reports Requested by the Workers' Compensation Appeals Board or the Administrative Director: Each additional page. Maximum of six pages absent mutual agreement

$24.54

WC008

Chart notes: First page

$10.58

 

Chart Notes: Each additional page. Maximum of six pages absent mutual agreement.

$0.25

WC009

Duplicate Reports: Up to the first 15 pages.

$10.58

 

Duplicate Reports: Each additional page after the first 15 pages

$0.25

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.

 


Our Work Comp Wizard software, which is the foundational tool of all DaisyBill products, automatically calculates reimbursements using the most recent Medicare files and DWC reimbursement formulas. Work Comp Wizard subscriptions are just $49 per month, come with a free three-day trial, and are cancellable at any time.

TRY THE WORK COMP WIZARD


[1] Link to blog.

[2] Full text here.

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