Some procedures/services are not accompanied by allowable fees. Procedures/services denoted "by report" (BR) in the
maximum fee column are too unusual or variable in the nature of their performance, too new, or too infrequently
performed to permit the assignment of a maximum fee. Fees for such procedures/services need to be justified "by
report." The report should contain sufficient supportive information to permit proper identification. Pertinent information
should be furnished concerning the nature, extent, and need for the procedure or service, the time, the skill, and
equipment necessary, etc. For any procedure/service where the maximum fee is "BR," the health care provider shall
establish a charge that is consistent with other maximum fees shown in the Schedule. The insurance carrier or selfinsured
employer should review all submitted "BR" amounts to assure that an excessive charge for services provided is
not occurring. Note also that for any procedures/services not listed within this Fee Schedule, the associated
charge(s) will need to be substantiated "by report" (BR).
DEFINITIONS
New Patient: One who has not received any professional services from the physician or another physician of the same
specialty who belongs to the same group practice, within the past three years.
Established Patient: One who has received professional services from the physician or another physician of the same
specialty who belongs to the same group practice, within the past three years. In the instance where a physician is on call
for or covering for another physician, the patient's encounter will be classified as it would have been by the physician who
is not available.
Note that no distinction is made between new and established patients in the emergency department. E / M services in
the emergency department category may be reported for any new or established patient who presents for treatment in the
emergency department.
