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2017 Work Comp Reimbursement Cheat Sheet

March 1, 2017 by Catherine Montgomery

This post includes payment information for 2017 dates of service only. For reimbursement changes effective January 1, 2018 see our Ultimate 2018 Work Comp Reimbursement Cheat Sheet.

In recent weeks, much of our coverage was devoted to the changing 2017 Physician and Non-Physician portion of the Official Medical Fee Schedule (OMFS). Today, after more than a month of waiting, those changes become effective.

We’ve compiled a cheat sheet of frequently-used workers’ comp Evaluation & Management codes, along with California-specific work comp codes and a pair of newly-reimbursable codes for prolonged non-face-to-face services. Use this page as a reference guide to ensure that your practice is reimbursed correctly for all dates of service from March 1 on.

1. Evaluation & Management

Evaluation & Management services are the bread and butter of many provider practices. The table below compares old and new reimbursements for E&M services on both the facility and non-facility fee schedule. All E&M reimbursements increase, usually by about 5%.

CPT Code

Description

Facility Fee

Feb 2017

Facility Fee

Mar 2017

 Facility

Fee % Change

Non

Facility Fee

Feb 2017

Non Facility Fee March 2017

Non Facility Fee % Change

99202

Office/outpatient visit new

$63.85

$67.44

+5.62%

$97.38

$102.77

+5.54%

99203

Office/outpatient visit new

$97.08

$101.66

+4.72%

$139.98

$147.37

+5.28%

99204

Office/outpatient visit new

$164.64

$172.54

+4.80%

$212.48

$222.40

+4.67%

99205

Office/outpatient visit new

$213.86

$224.62

+5.03%

$265.64

$279.16

+5.09%

99211

Office/outpatient visit est

$11.72

$12.30

+4.95%

$26.51

$28.40

+7.13%

99212

Office/outpatient visit est

$31.84

$33.90

+6.47%

$56.99

$60.39

+5.97%

99213

Office/outpatient visit est

$64.81

$67.97

+4.88%

$94.89

$100.18

+5.57%

99214

Office/outpatient visit est

$99.54

$104.94

+5.42%

$139.49

$147.02

+5.40%

99215

Office/outpatient visit est

$140.90

$148.31

+5.26%

$187.26

$197.13

+5.27%

2. California-Specific Codes

Reimbursement rates for the California-specific codes created by the DWC in 2013 are not directly affected by changes to the conversion factor or RVU file. Nonetheless, CCR § 9789.12.14 specifies that they must be updated annually “in accordance with the Medicare Economic Index.” The table below lists the new fees for 2017 California-Specific Codes, effective March 1, alongside the 2016 rates. All of the reimbursements are due for minor increases this year, 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

3. CPT Codes 99358 and 99359 for Non-Face-To-Face Services

CPT Codes 99358 and 99359 allow physicians or nonphysician practitioners to bill for prolonged services that are not face-to-face. Since these codes are newly reimbursable, a year-to-year comparison is not applicable . It’s interesting to note, however, that the $149.40 reimbursement for code 99358 is greater than the new $147.02 non-facility reimbursement for E&M Code 99214.

CPT Code

Description

Non-Facility and Facility Reimbursement 3/1/2017

99358

Prolonged evaluation and management service before and/or after direct patient care; first hour

$149.40

99359

Each additional 30 minutes (List separately in addition to code 99358 for prolonged service)

$71.96


The DaisyBill OMFS Calculator – one of the six products offered through our Work Comp Wizard – is updated every time the DWC adjusts the workers’ comp fee schedule. That means that our clients never have to worry about out-of-date reimbursements. Should you ever need to access old reimbursements, simply enter a date of service prior to the date of the last OMFS changes.

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 2017 work comp reimbursements instantly, and you’ll gain access to a suite of other workers’ comp billing tools.

TRY THE OMFS CALCULATOR

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