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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. We’re hosting a webinar on all OMFS changes on January 16.

Below are the new reimbursements for evaluation and management (E/M) services, as well as the most frequently-billed “Other” services. Next week, we’ll publish the reimbursement changes for the top surgery and radiology CPT codes.

Use the handy charts included in this blog for quick and easy reference, sign up for our 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 sign up for our free webinar on 2018 OMFS changes as well. Together, we’ll hit the ground running in the new year.

SIGN UP: 2018 OMFS CHANGES WEBINAR


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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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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