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Reimbursement Change: 2018 E/M and Other Services Cheat Sheet

December 15, 2017 by Catherine Montgomery

DWC Official Medical Fee ScheduleIt’s that time of year: the Division of Workers' Compensation (DWC) recently announced changes to the reimbursements for the Physician Fee Schedule. These reimbursement changes are effective for all dates of service on or after January 1, 2018. 

Below are the new reimbursements for evaluation and management (E/M) services, as well as the most frequently-billed “Other” services. For even more 2018 reimbursement info, see our Ultimate 2018 Workers' Comp Reimbursement Cheat Sheet.

Use the handy charts included in this blog for quick and easy reference, download our recent webinar, and subscribe to DaisyBill’s Work Comp Wizard, which includes all of the reimbursement changes that take effect on January 1st.

Evaluation and Management (E/M) Services

Reimbursement for all E/M codes will be modestly higher, generally under 3%, with the exception of an 8.09% increase for CPT code 99211.

The table below lists each E/M code with the current reimbursement and the new reimbursement for 2018 with both the raw difference and difference in percentage.

Billing Code Description Reimbursement (Non-Facility) December 2017 Reimbursement (Non-Facility)     January 2018    Reimbursement Difference Percent Change 
99202 Office/outpatient visit new $102.77 $104.53 $1.76 +1.68%
99203 Office/outpatient visit new $147.37 $149.04 $1.67 +1.12%
99204 Office/outpatient visit new $222.40 $225.94 $3.54 +1.57%
99205 Office/outpatient visit new $279.16 $283.28 $4.12 +1.45%
99211 Office/outpatient visit est $28.40 $30.90 $2.50 +8.09%
99212 Office/outpatient visit est $60.39 $61.67 $1.28 +2.08%
99213 Office/outpatient visit est $100.18 $101.39 $1.21 +1.19%
99214 Office/outpatient visit est $147.02 $149.32 $2.30 +1.54%
99215 Office/Outpatient Visit (est) $197.13 $200.52 $3.39 +1.69%
99233 Subsequent Hospital Care $139.26 $140.73 $1.47 +1.04%

Other Services

Reimbursement rates for various “other” services all increase, from just over a single percent, all the way up to a 12.11% increase for CPT code 95851 and a 17.02% jump for CPT code 95852, both for range of motion measurements.

Billing Code Description  Reimbursement  (Non-Facility)  December 2017   Reimbursement  (Non-Facility)  January 2018  Reimbursement  Difference  Percent  Change

T1013

 Other carot sten
120 days 

$0.00

$0.00

N/A

N/A

90837

Psytx w pt 60 minutes

$166.71

$174.87

$8.16

+4.67%

90875

Psychophysiological therapy

$82.31

$84.79

$2.48

+2.92%

95831 

Limb muscle testing manual

$43.81

$46.70

$2.89

+6.19%

95832

Hand muscle testing manual

$43.02

$45.61

$2.59

 

+5.68%

95834 

Body muscle testing manual

$72.73

$76.82

$4.09

+5.32%

95851

Range of motion measurements

$25.40

$28.90

$3.50

+12.11%

 95852

Range of motion measurements

$22.03

$26.55

$4.52

+17.02%

95886

Musc test done w/n test comp

$63.00

$63.74

$0.74

+1.16%

96101 

Psycho testing by psych/phys

$105.22

$110.60

$5.38

+4.86%

98940

Chiropract manj 1-2 regions

$38.61

$39.61

$1.00

+2.52%

 99024

Postop followup visit

$0.00

$0.00

N/A

N/A

99354

Prolong e&m/psyctx serve o/p

$173.90

$177.39

$3.49

+1.97%

99358 

Prolong service w/o contact

$149.40

$150.99

$1.59

+1.05%

99359

Prolong service w/o contact add

$71.96

$72.74

$0.78

+1.07%

Stay tuned to this blog for the rest of the 2018 OMFS updates, as well as news regarding changes to the authorization and utilization review process. Remember to download our free webinar on 2018 OMFS changes as well. Together, we’ll hit the ground running in the new year.

 


We update our DaisyBill OMFS Calculator – one of the six products offered through our Work Comp Wizard – every time the Division of Workers’ Compensation (DWC) adjusts the workers’ comp fee schedule. That means that our clients never have to worry about outdated reimbursements.

Sign up below for a free trial of the Wizard OMFS Calculator.

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