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2018 Surgery Reimbursements: Cheat Sheet

December 20, 2017 by Catherine Montgomery

Official Medical Fee Schedule2018 is around the corner, and the Division of Workers’ Compensation (DWC) recently posted updates to the Official Medical Fee Schedule (OMFS), effective January 1. We’re detailing those changes here in our blog. As always, our OMFS Calculator will be up to date with all the changes for DaisyBill users.

Last week, we covered changes to reimbursements for E/M services. Today, we take a look at reimbursement changes for surgery. Later this week, we’ll post changes to reimbursements for radiology.

Use the chart below for quick and easy reference, and download our recent OMFS webinar. For more updated 2018 reimbursements, see our Ultimate 2018 Reimbursement Cheat Sheet.

Surgery Reimbursements

Most surgery services will see a modest increase in reimbursement, from less than a single percent to just under 7 percent. There are two notable exceptions to this trend. Reimbursement for CPT Code 17004 will actually drop in 2018 by 2.64%, from $209.61 to $204.21. Meanwhile, reimbursement for implanting neuroelectrodes (CPT Code 64555) skyrockets by over 83%, from $293.20 to $1762.01, a difference of $1468.81.

The table below features the codes our providers apply most frequently, in ascending order by code number. The data comes complete with a description of the service, the current reimbursement, the 2018 reimbursement, and the difference in both raw price and percentage.

Billing Code

Description

Reimbursement (Non-Facility) December 2017

Reimbursement (Non-Facility)     January 2018   

Reimbursement Difference

Percent Change 

11100

Biopsy skin lesion

$145.34

$150.86

$5.52

+3.66%

17000

Destruct premalg lesion

$93.08

$93.68

$0.60

+.64%

17004

Destroy premal lesions 15/>

$209.61

$204.21

$5.40

- 2.64%

 

20550

Inj tendon sheath/ligament

$71.83

$73.12

$1.29

+1.76%

 

20605

Drain/inj joint/bursa w/o us

$68.80

$70.07

$1.27

+1.81%

20610

Drain/inj joint/bursa w/o us

$82.38

$83.21

$0.83

+1%

20611

Drain/inj joint/bursa w/us

$124.99

$126.05

$1.06

+.84%

29823

Shoulder arthroscopy/surgery

$846.67

$856.33

$9.66

+1.13%

29826

Shoulder arthroscopy/surgery

$235.46

$236.79

$1.33

+.56%

29827

Arthroscop rotator cuff repr

$1435.53

$1449.80

$14.27

+.98%

29877

Knee arthroscopy/surgery

$847.05

$856.36

$9.31

+1.09%

36415

Routine venipuncture $3.60 $3.60 N/A N/A

62284

Injection for myelogram $263.75 $271.57 $7.82 +2.88%

64450

N block other peripheral $112.28 $114.24 $1.96 +1.72%

64483

Inj foramen epidural l/s $306.84 $312.22 $5.38 +1.72%

64484

Inj foramen epidural add-on $121.61 $130.51 $8.90 +6.82%

64493

Inj paravert f jnt l/s 1 lev $240.78 $245.50 $4.72 +1.92%

64494

Inj paravert f jnt l/s 2 lev $119.31 $121.29 $1.98 +1.63%

64555

Implant neuroelectrodes $293.20 $1762.01 $1468.81 +83.36%

As mentioned above, we’ll keep our readers informed of all the changes coming to work comp in 2018. Subscribe to the blog, download our webinar, and (for those readers who are not DaisyBill clients), feel free to take our OMFS Calculator for a spin with a free trial.

  TRY THE OMFS CALCULATOR

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