California’s Division of Workers’ Compensation (DWC) posted update orders to two sections of the Official Medical Fee Schedule (OMFS), both effective July 1, 2018.*
The DWC ordered changes to the Physician and Non-physician Practitioner fee schedule, as well as the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.
The orders affect reimbursement for 5 codes in total, 4 for Physician Services and one for DMEPOS.
Physician and Non-Physician Practitioner Services
A June 26 DWC order adjusts the Physician Services portion of the OMFS to align with three changes to Medicare, as California Labor Code Section 5307.1 mandates:
- The Centers for Medicare and Medicaid Services (CMS) July 1, 2018 Physician Fee Schedule releases on July 1, 2018. The DWC adopts changes to the Medicare Physician Fee Schedule Relative Value File, adjusting California Code of Regulations (CCR) Section 9789.19 accordingly.
- Medicare’s quarterly update to the Practitioner PTP National Correct Coding Initiative (NCCI) Edits is effective July 1, 2018. Four NCCI Edits files adjust CCR §9789.19.
- Medicare’s quarterly update to the Practitioner Services Medically Unlikely Edits (MUE) are effective July 1, 2018, adjusting CCR §9789.19. The changes are available on the CMS website.
Changes to reimbursement are as follows:
|Procedure Code||Status Code||Procedure||Modifier||Reimbursement (Non-Facility) June 30, 2018||
Reimbursement (Non-Facility) July 1, 2018
|G0460||A||Autologous prp for ulcers||N/A||By Report (BR)||$267.69||$267.69|
|Q0477||X||Pwr module pt cable lvad rpl||N/A||$121.99||$883.62||$761.63|
|71045||A||X-ray exam chest 1 view||N/A||$28.01||$31.17||$3.16|
|71045||A||X-ray exam chest 1 view||TC||$15.57||$18.73||$3.16|
A June 18 order adopts the Medicare Interim Final Rule With Comment Period (CMS-1687-IFC) regarding adjustments for rural and non-contiguous areas. The DWC also adopts revisions to the Durable Medical Equipment Fee Schedule effective July 1, 2018.
These updates adjust CCR §9789.60, affecting reimbursement for one procedure code:
|Procedure Code||Status Code||Procedure||Reimbursement June 30, 2018||Reimbursement July 1, 2018||Reimbursement Change|
Pwr module pt cable lvad rpl
We’ll keep readers updated on any further changes to the OMFS. And — as always — DaisyBill clients can rest assured that our software is up to date with the latest information necessary for accurate reimbursement calculations.
*The DWC also ordered updates to the Hospital Outpatient/Ambulatory Surgical Center (ASC) section of the OMFS, effective July 1, 2018. However, these updates do not affect reimbursement rates.