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2017 Physician Fee Schedule Changes Effective July 1

June 14, 2017 by Catherine Montgomery

Mark your calendar! The California Division of Workers’ Compensation (DWC) issued a Newsline this week announcing the next wave of changes to the Physician and Non-Physician Practitioner Services Portion Official Medical Fee Schedule (OMFS).[1] While none of the reimbursement changes are very noticeable, a host of new codes will roll into effect on July 1, 2017.

The DWC order adds over a dozen brand new “by report” procedure codes to the Physician Fee Schedule starting in the 3rd quarter of 2017.

Procedure Code

Description

Reimbursement

Q9984

Kyleena

BR

Q9985

Inj, hydroxyprogesterone, NO

BR

Q9986

Inj, Makena

BR

Q9987

Pathogen test for platelets

BR

Q9988

Platelets, pathogen reduced

BR

Q9989

Ustekinumab IV Inj, 1 mg

BR

0469T

Rta polarize scan oc scr bi

BR

0470T

Oct skn img acquisj i&r 1st

BR

0471T

Oct skn img acquisj i&r addl

BR

0472T

Prgrmg io rta eltrd ra

BR

0473T

Reprgrmg io rta eltrd ra

BR

0474T

Insj aqueous drg dev io rsvr

BR

0475T

Rec ftl car sgl 3 ch i&r

BR

0476T

Rec ftl car sgl elec tr data

BR

0477T

Rec ftl car sgl xrtj alys

BR

0478T

Rec ftl car 3 ch rev i&r

BR

The “T” designation at the end of certain procedure codes denotes a temporary code. The CMS will monitor usage of these ‘T’ codes and determine whether to replace the temporary status with an established Level I code with a set reimbursement amount.

As you probably know by now, calculating workers’ comp reimbursement amounts for procedure codes is a laughably complicated process. Each reimbursement calculation requires one of two formulas – one for facility places of service and one for non-facility. In turn, each formula relies on three Relative Value Units, or RVUs. For dates of service on or after July 1, 2017, the DWC uses Medicare’s Quarter 3 RVU files. You may download these files from the Medicare website by following this link.

The latest DWC update also includes Correct Coding Initiative and Medically Unlikely Edits. Correct Coding Initiative (CCI) edits occur when two procedure codes are incorrectly billed together. Medically Unlikely Edits (MUEs) occur when an unlikely number of units is assigned to a single procedure code. Both CCI edits and MUEs result in a $0 reimbursement for the incorrectly billed procedure code.

DaisyBill’s OMFS Calculator, part of our new Work Comp Wizard, automatically calculates reimbursements using the most recent RVU files and conversion factors and incorporating CCI edits and MUEs. To make accurate billing even easier, use our Physician Fee Schedule Alerts feature to register your most frequently-used codes. Any time the DWC issues an adjustment to the OMFS, you’ll receive an instant email alert noting any changes to your favorite codes. Stay tuned – we’re expecting more adjustments to the OMFS in the weeks ahead.

Work Comp Wizard subscriptions are just $49 per month, come with a free three-day trial, and are cancellable at any time. You can learn more on our website.

TRY THE OMFS CALCULATOR



[1] Full text of the DWC announcement here.

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