2017 Work Comp Reimbursement Cheat Sheet
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
DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.
