Enriquez Esquivel, Edelmin

Lien claimant Monrovia Memorial Hospital (MMH), a licensed Long-Term Acute Care Hospital exempt from the Official Medical Fee Schedule, provided an authorized cervical spine fusion surgery to applicant on March 26-27, 2019, billing $94,529.47 and receiving $24,836.67 from defendant. The WCJ found the reasonable value of services to be $31,442.51 based on the testimony of defendant's witness Donald Hodge, who used a fee-schedule averaging approach drawn from three area hospitals. MMH sought reconsideration, arguing the WCJ failed to consider its Kunz study evidence of usual and customary reimbursement and improperly relied on a fee-schedule analysis when MMH is exempt. The Appeals Board granted reconsideration, noting the record lacked any showing that Hodge qualified as an expert, defendant offered no admitted documentary evidence, and the WCJ's decision did not address the Kunz study or certain exhibits. The Board deferred a final decision pending further review of the merits and possible development of the record.