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Ultimate 2018 Workers’ Compensation Reimbursement Cheat Sheet

February 2, 2018 by Catherine Montgomery

workers compensation reimbursements 2018Here it is: your complete, downloadable go-to resource for California workers’ comp reimbursement rates in 2018. This guide features the Official Medical Fee Schedule (OMFS) reimbursements for the procedure codes providers use most, including:

  • Evaluation & Management (E/M)
  • Surgery
  • Radiology (Professional Services)

...and more, plus reimbursements for medical-legal services! All OMFS reimbursements are effective for dates of service on or after January 1, 2018. 

To download the cheat sheet as a printable pdf, head to our Webinar Library. While you’re there, feel free to download our 2018 OMFS Webinar video and slides as well.

DOWNLOAD ULTIMATE 2018 CHEAT SHEET

Evaluation and Management (E/M) Services

Reimbursement for all E/M codes are modestly higher in 2018 (generally under 3%), with the exception of an 8.09% increase for CPT code 99211. 

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%

 

Surgery

Most surgery reimbursements saw a modest increase, from less than a single percent to just under 7 percent. There are two notable exceptions: CPT Code 17004 dropped by 2.64%, from $209.61 to $204.21. Meanwhile, reimbursement for implanting neuroelectrodes (CPT Code 64555) skyrocketed by over 83%, from $293.20 to $1762.01, a difference of $1468.81.

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%

 

Radiology (Professional Services, Modifier -26)

Most services saw a modest increase of less than 2%, with the exception of CPT Code 73100 for an x-ray examination of the wrist, which rose by over 5% to $12.02.

Billing Code

Description

Reimbursement (Non-Facility) December 2017

Reimbursement (Non-Facility)     January 2018   

Reimbursement Difference

Percent Change 

72040

X-ray exam neck spine 2-3 vw

$15.20

$15.38

$0.18

+1.17%

72070

X-ray exam thorac spine 2vws

$15.20

$15.38

$0.18

+1.17%

72100

X-ray exam l-s spine 2/3 vws

$15.20

$15.38

$0.18

+1.17%

 

72110

X-ray exam l-2 spine 4/>vws

$21.24

$21.47

$0.23

 

+1.07%

 

72148

Mri lumbar spine w/o dye

$100.60

$101.16

$0.56

+.55%

72170

X-ray exam of pelvis

$11.84

$11.97

$0.13

+1.09%

73020

X-ray exam of shoulder

$10.91

$11.02

$0.11

+1%

73030

X-ray exam of shoulder

$12.82

$12.96

$0.14

+1.08%

73100

 X-ray exam of wrist 

$11.37

$12.02

$0.65

+5.41%

73110

 X-ray exam of wrist 

$11.84

$11.97

$0.13

+1.09%

73120

X-ray exam of hand 

$11.37

$11.50

$0.13

+1.13%

73130

X-ray exam of hand  $11.84 $11.97 $0.13 +1.09%

73221

Mri joint upr extrem w/o dye $92.18 $92.66 $0.48 +.52%

73560

X-ray exam of knee 1 or 2 $11.37 $11.50 $0.13 +1.13%

73562

X-ray exam of knee 3 $12.82 $12.96 $0.14 +1.08%

73564

X-ray exam knee 4 or more $15.20 $15.38 $0.18 +1.17%

73610

X-ray exam of ankle $11.84 $11.97 $0.13 +1.09%

73721

Mri jnt of lwr extre w/o dye $91.66 $92.66 $1.00 +1.08%

76881

Us compl joint r-t w/img $42.66 $43.14 $0.48 +1.11%

 

Medical-Legal Services

Codes ML100, ML102, and ML103 are flat-rate service-based fees, while ML101, ML104, ML105, and ML106 are time-based. Reimbursement rates remain unchanged from the 2017 rates. All medical-legal billing code modifiers (93, 94, and 95) are included in the tables below.

Medical-Legal Reimbursements, Non-Time-Based

Billing Code

Procedure

Modifier(s)

Reimbursement  

ML100

Missed Appointment

N/A

By Report

ML102

Basic Comprehensive Medical-Legal Evaluation

None

$625.00

ML102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter)

$687.50

 

ML102

Basic Comprehensive Medical-Legal Evaluation

94 (AME)

$781.25

ML102

Basic Comprehensive Medical-Legal Evaluation

95 (Panel QME)

$625.00

ML102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 94 (AME)

$843.75

ML102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 95 (Panel QME)

$687.50

ML103

Complex Comprehensive Medical-Legal Evaluation

None

$937.50

ML103

Complex Comprehensive Medical-Legal Evaluation

93 (With Interpreter)

$1,031.25

ML103

Complex Comprehensive Medical-Legal Evaluation

94 (AME)

$1,171.88

ML103

Complex Comprehensive Medical-Legal Evaluation

95 (Panel QME)

$937.50

ML103

Complex Comprehensive Medical-Legal Evaluation 93 (With Interpreter) + 94 (AME) $1,265.63

ML103

Complex Comprehensive Medical-Legal Evaluation 93 (With Interpreter) + 95 (Panel QME) $1,031.25

 

Medical-Legal Reimbursements, Time Based (ML101, ML104, ML105, ML106)

Time in Minutes

Units

No Modifier

Modifier 94 (AME)

Modifier 95 (Panel QME)

15 1 $62.50 $78.13 $62.50 
30 2 $125.00 $156.26 $125.00 
45 3 $187.50 $234.39  $187.50
60 4 $250.00 $312.52 $250.00 
75 5 $312.50 $390.65 $312.50 
90 6 $375.00 $468.78 $375.00 
105 7 $437.50 $546.91 $437.50 
120 8 $500.00 $625.04 $500.00
135 9 $562.50 $703.17 $562.50 
150 10 $625.00 $781.30 $625.00 
165 11 $687.50 $859.43 $687.50 
180 12 $750.00 $937.56 $750.00 
195 13 $812.50 $1,015.69 $812.50 
210 14 $875.00 $1,093.82 $875.00 
225 15 $937.50 $1,171.95 $937.50 
240 16 $1,000.00 $1,250.08 $1,000.00 
255 17 $1,062.50 $1,328.21 $1,062.50 
270 18 $1,125.00 $1,406.34 $1,125.00 
285 19 $1,187.50 $1,484.47 $1,187.50 
300 20 $1,250.00 $1,562.60 $1,250.00 
315 21 $1,312.50 $1,640.73 $1,312.50 
330 22 $1,375.00 $1,718.86 $1,375.00 

 

Other Services

Reimbursement rates for various other services also increased, 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

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%

 


Get a handle on the OMFS. DaisyBill's Work Comp Wizard includes our exclusive OMFS Calculator, constantly updated to reflect the most current reimbursements. Make billing easier, faster, better. Try the Wizard today!

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