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2017 California-Specific Code Reimbursements Updated

February 23, 2017 by Catherine Montgomery

Earlier this month, we reported on the upcoming changes to the Physician and Non-Physician Services section of the Official Medical Fee Schedule (OMFS). California’s Division of Workers’ Compensation adopted these changes to conform to the Medicare payment system, and the changes roll into effect on March 1, 2017. New conversion factors and an updated RVU file combine to change the reimbursement amounts for all procedure codes – we covered the changes to the twenty most commonly-used Physician and Non-Physician HCPCS in our analysis. Lost in the shuffle of these changes are another critical shift: Changes to the California-specific codes laid out in CCR § 9789.12.14.

Prior to 2014, a suite of California-specific codes were created by the DWC to cover services for which there are no appropriate CPT codes or HCPCS, such as the State of California Primary Physician Progress Report (DWC form PR-2). While the reimbursement rates for these codes are not directly affected by changes to the conversion factor or RVU file, CCR § 9789.12.14 specifies that they must nonetheless be updated annually “in accordance with the Medicare Economic Index.”

The table below lists the new fees for California Specific Codes, effective March 1, 2017, alongside the 2016 rates. All of the reimbursements are due for minor increases in 2017, most by about 1%.

Code

Description

Reimbursement Effective 1/1/2016

Reimbursement Effective 3/1/2017

Percent Change

WC001

Doctor's First Report of Occupational Illness or Injury (Form 5021)

$0.00

$0.00

N/A

WC002

Treating Physician's Progress Report (Form PR-2)

$12.14

$12.29

+1.24%

WC003

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): First page

$39.42

$39.89

+1.19%

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): Each additional page. Maximum of six pages absent mutual agreement.

$23.80

$24.54

+3.11%

WC004

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): First page

$39.42

$39.89

+1.19%

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): Each additional page. Maximum of seven pages absent mutual agreement.

$23.80

$24.54

+3.11%

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: First page

$39.42

$39.89

+1.19%

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: Each additional page. Maximum of six pages absent mutual agreement

$23.80

$24.54

+3.11%

WC007

Consultation Reports Requested by the Workers' Compensation Appeals Board or the Administrative Director: First page

$39.42

$39.89

+1.19%

Consultation Reports Requested by the Workers' Compensation Appeals Board or the Administrative Director: Each additional page. Maximum of six pages absent mutual agreement

$23.80

$24.54

+3.11%

WC008

Chart notes: First page

$10.45

$10.58

+1.24%

Chart Notes: Each additional page. Maximum of six pages absent mutual agreement.

$0.25

$0.25

N/A

WC009

Duplicate Reports: Up to the first 15 pages.

$10.45

$10.58

+1.24%

Duplicate Reports: Each additional page after the first 15 pages

$0.25

$0.25

N/A

WC010

Duplication of X-Ray

$5.23

$5.29

+1.15%

WC011

Duplication of Scan

$10.45

$10.58

+1.24%

WC012

Missed Appointments. No fee prescribed /  Non-reimbursable absent agreement.

$0.00

$0.00

N/A

DaisyBill’s OMFS Calculator – one of the six products offered through our Work Comp Wizard – already includes these changes for dates of service on or after March 1. Should you ever need the old figures past that date, you can calculate previous reimbursements through our historical database – simply enter a date of service prior to March 1, 2017.

If you’re curious about our Calculator, sign up below for a three-day trial to the Work Comp Wizard. You’ll be able to start calculating reimbursements instantly, and you’ll gain access to our other workers’ comp tools.

TRY THE OMFS CALCULATOR

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