Payment for Hardware Used in Complex Spinal Procedures under California’s Official Medical Fee Schedule for Injured Workers

by Barbara O. Wynn, Giacomo Bergamo

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This study updates analyses from a 2003 RAND report examining Official Medical Fee Schedule (OMFS) payments for workers' compensation spinal surgery discharges from acute care hospitals. The OMFS maximum allowable fees for inpatient hospital care are based on 120 percent of the amount that would be payable under the Medicare prospective payment system for inpatient services. In addition, separate payment is made for hardware and instrumentation used during complex spinal surgeries. The 2003 RAND report concluded that the fees should be adequate without the additional payment. Senate Bill 228 (Alarcon, 2003) provides for the additional payments only until the Administrative Director (AD) of the Division of Workers' Compensation (DWC) adopts a regulation specifying separate reimbursement, if any, for the hardware and instrumentation.

The research described in this report was prepared for the Commission on Health and Safety and Workers’ Compensation and the Division of Workers’ Compensation, California Department of Industrial Relations and was conducted by the RAND Institute for Civil Justice and RAND Health.

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