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California Division of Workers' Compensation Posts Updated Physician Fee Schedule FAQs Regarding Physician-Dispensed Durable Medical Equipment
By Press Release - September 17, 2014

The Division of Workers’ Compensation (DWC) has been receiving an increasing number of inquiries regarding the reimbursement of durable medical equipment (DME) dispensed by physicians. Some members of the public have asked whether the physician fee schedule Medically Unlikely Edits (MUE) bar payment to a physician for DME dispensed to his or her patient.

Under the physician fee schedule regulations, the physician MUE apply to services billed under the physician fee schedule. DME dispensed by a physician is billed under the “durable medical equipment, prosthetics, orthotics and supplies” (DMEPOS) fee schedule, not the physician fee schedule. Therefore, the physician fee schedule MUE are not applicable. A physician can bill and be reimbursed for medically necessary durable medical equipment dispensed to his or her patient.

The updated FAQs page addresses statutory and regulatory provisions relating to the following:

  • The non-applicability of the physician MUE to physician-dispensed DME
  • The calculation of maximum reasonable fees for DME under the DMEPOS
  • The additional statutory limitation on maximum fees for a “dangerous device” dispensed by a physicianThe difference between the Medicare DMEPOS ground rules and the workers’ compensation rules

The FAQs can be found on the Official Medical Fee Schedule web page.

###

California Department of Industrial Relations, P.O. Box 420603 · San Francisco, CA · 94142-0603 · www.dir.ca.gov

 
 

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