Effective January 1, 2016 every reimbursement amount changes in the Physician Fee Schedule.  

On Monday the Division of Workers’ Compensation (DWC) posted major revisions to the Official Medical Fee Schedule (OMFS), updating the fee schedule for Physician Services and Non-Physician Practitioner Services.

For dates of service on or after January 1, 2016, the adjustments include updates to the RVU files, Conversion Factors, NCCI Edits and California specific codes.

Specific updates to Physician Services and Non-Physician Practitioner Services.  

• Adopts CMS’ Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU16A and related files.
• Updates the Conversion Factors, applying the Medicare relative value scale adjustments and the Medicare Economic Index (MEI) inflation increase to the transitional conversion factors set forth in the regulation.
• Adopts the 2016 National Correct Coding Initiative Edits Policy Manual.
• Updates the California specific codes with the MEI inflation increase (+1.1%).

How to access updated fee schedule documents and files:

• CMS’ Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU16A

• Open DWC Official Medical Fee Schedule Physician Fee Schedule Regulations.
• Page 71 is the beginning of subsection (c) of § 9789.19 Update Table.
• On page 72, find the section labeled “CMS’ Medicare National Physician Fee Schedule Relative Value File [Zip].”
• Download the RVU16A file for the January 1, 2016 update.

• Conversion Factors adjusted for MEI and Relative Value Scale adjustment factor

• Open DWC Official Medical Fee Schedule Physician Fee Schedule Regulations.
• Page 71 is the beginning of subsection (c) of § 9789.19 Update Table, which lists documents and data for services rendered on or after January 1, 2016.
• On page 72, find the section labeled “Conversion Factors adjusted for MEI and Relative Value Scale adjustment factor.”
• The Conversion Factors for 2016 dates of service are as follows:

• Anesthesia Conversion Factor: $29.3852
• Surgery Conversion Factor: $48.2013
• Radiology Conversion Factor: $47.4598
• Other Services Conversion Factor: $42.4599

• National Correct Coding Initiative Policy Manual 

• Open DWC Official Medical Fee Schedule Physician Fee Schedule Regulations.
• Page 71 is the beginning of subsection (c) of § 9789.19 Update Table.
• On page 72, find the section labeled “CCI Edits.”
• Download the “NCCI Policy Manual for Medicare Services - Effective January 1, 2016 [ZIP, 761MB] ”

• Medi-Cal Rates file 

• Open DWC Official Medical Fee Schedule Physician Fee Schedule Regulations.
• Page 71 is the beginning of subsection (c) of § 9789.19 Update Table.
• On page 74, find the section labeled Medi-Cal Rates – DHCS

For more information, see:

• Physician services section of the DWC’s OMFS webpage
• Newsline 2015-109 of the DIR