CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 668Introduced by Senator HurtadoFebruary 20, 2025 An act to amend Section 5307.6 of the Labor Code, relating to workers compensation. LEGISLATIVE COUNSEL'S DIGESTSB 668, as introduced, Hurtado. Workers compensation: medical-legal expenses: fee schedule.Existing law establishes a workers compensation system, which provides for comprehensive medical-legal evaluations to assist in the resolution of contested claims. Under existing law, fees for medical-legal evaluations are charged at a rate not to exceed a physicians regular fee, or the fee schedule set by the Administrative Director of the Division of Workers Compensation, whichever is lower. Existing law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Existing law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised.This bill would authorize the medical director to adjust the fee schedule every 2 years based on an evaluation of certain medical practice costs, including increases in the conversion factor and the per-page cost of reviewing records, as specified. The bill would require the medical director to update the fee schedule at specified times, including at the time they adopt and revise the reasonable maximum fees for, among other things, drugs and pharmacy services provided to an injured employee.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 668Introduced by Senator HurtadoFebruary 20, 2025 An act to amend Section 5307.6 of the Labor Code, relating to workers compensation. LEGISLATIVE COUNSEL'S DIGESTSB 668, as introduced, Hurtado. Workers compensation: medical-legal expenses: fee schedule.Existing law establishes a workers compensation system, which provides for comprehensive medical-legal evaluations to assist in the resolution of contested claims. Under existing law, fees for medical-legal evaluations are charged at a rate not to exceed a physicians regular fee, or the fee schedule set by the Administrative Director of the Division of Workers Compensation, whichever is lower. Existing law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Existing law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised.This bill would authorize the medical director to adjust the fee schedule every 2 years based on an evaluation of certain medical practice costs, including increases in the conversion factor and the per-page cost of reviewing records, as specified. The bill would require the medical director to update the fee schedule at specified times, including at the time they adopt and revise the reasonable maximum fees for, among other things, drugs and pharmacy services provided to an injured employee.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION
Senate Bill
No. 668
Introduced by Senator HurtadoFebruary 20, 2025
Introduced by Senator Hurtado
February 20, 2025
An act to amend Section 5307.6 of the Labor Code, relating to workers compensation.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
SB 668, as introduced, Hurtado. Workers compensation: medical-legal expenses: fee schedule.
Existing law establishes a workers compensation system, which provides for comprehensive medical-legal evaluations to assist in the resolution of contested claims. Under existing law, fees for medical-legal evaluations are charged at a rate not to exceed a physicians regular fee, or the fee schedule set by the Administrative Director of the Division of Workers Compensation, whichever is lower. Existing law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Existing law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised.This bill would authorize the medical director to adjust the fee schedule every 2 years based on an evaluation of certain medical practice costs, including increases in the conversion factor and the per-page cost of reviewing records, as specified. The bill would require the medical director to update the fee schedule at specified times, including at the time they adopt and revise the reasonable maximum fees for, among other things, drugs and pharmacy services provided to an injured employee.
Existing law establishes a workers compensation system, which provides for comprehensive medical-legal evaluations to assist in the resolution of contested claims. Under existing law, fees for medical-legal evaluations are charged at a rate not to exceed a physicians regular fee, or the fee schedule set by the Administrative Director of the Division of Workers Compensation, whichever is lower. Existing law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Existing law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised.
This bill would authorize the medical director to adjust the fee schedule every 2 years based on an evaluation of certain medical practice costs, including increases in the conversion factor and the per-page cost of reviewing records, as specified. The bill would require the medical director to update the fee schedule at specified times, including at the time they adopt and revise the reasonable maximum fees for, among other things, drugs and pharmacy services provided to an injured employee.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 5307.6 of the Labor Code is amended to read:5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
SECTION 1. Section 5307.6 of the Labor Code is amended to read:
### SECTION 1.
5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years. The(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.
5307.6. (a) (1) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, which 4620 that shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she expenses. The schedule shall be adopted and revised at the time the administrative director adopts and revises the medical fee schedule pursuant to Section 5307.1. 5307.1, and, in any case, at least every two years.
The
(2) The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which that provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which that additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.
(3) The administrative director may adjust the fee schedule every two years based on an evaluation of medical practice costs, including consideration of increases in the conversion factor and the per-page cost of reviewing records as informed by the most current Medicare Economic Index.
(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider charge in excess of his or her their usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.
(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employers or carriers subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.
(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.
(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.