Regulations
| 9792.27.5....MTUS Drug Formulary - Off-Label Use | |
| (a) Off-label use of a drug shall be in accordance with the MTUS Treatment Guidelines and rules and the MTUS Drug Formulary. Â (b) Authorization through prospective ...more | |
| 9792.27.6....MTUS Drug Formulary - Access to Drugs Not Listed as an Exempt Drug on the MTUS Drug List | |
| (a) Drug treatment that is in conformity with the MTUS Treatment Guidelines is presumed correct on the issue of extent and scope of medical treatment pursuant to section ...more | |
| 9792.27.7....MTUS Drug Formulary - Brand Name Drugs; Generic Drugs | |
| The documentation must include the patient-specific factors that support the physician's determination that the brand name drug is medically necessary. The physician must ...more | |
| 9792.27.8....Physician-Dispensed Drugs | |
| (a) Drugs dispensed by a physician must be authorized through prospective review prior to being dispensed, except as provided in subdivision (b), section 9792. 27. 12 ( ...more | |
| 9792.27.9....Compounded Drugs | |
| (a) Compounded drugs must be authorized through prospective review prior to being dispensed. When it is necessary for medical reasons to prescribe or dispense a ...more | |
| 9792.5....Payment for Medical Treatment | |
| This section is applicable to medical treatment rendered before October 15, 2011. Â (2) âMedical treatmentâ means the treatment to which an employee is ...more | |
| 9792.5.0....Definitions | |
| Â (b) âBilling Agentâ means a person or entity that has contracted with a health care provider or health care facility to process bills for services provided ...more | |
| 9792.5.1....Medical Billing and Payment Guide; Electronic Medical Billing and Payment Companion Guide; Various Implementation Guides | |
| Â (3) California Division of Workers' Compensation Medical Billing and Payment Guide, Version 1. 2. 1, for bills submitted on or after February 12, 2014. Â (4) ...more | |
| 9792.5.10....Independent Bill Review - Document Filing | |
| (a) The independent bill reviewer assigned the request shall review all information provided by the parties to determine if any additional information is necessary to ...more | |
| 9792.5.11....Withdrawal of Independent Bill Review | |
| The provider may, concurrent with written notice to the claims administrator, withdraw a request for independent bill review at any time prior to the issuance of a final ...more | |
