2018 Surgery Reimbursements: Cheat Sheet
2018 is around the corner, and the Division of Workers’ Compensation (DWC) recently posted updates to the Official Medical Fee Schedule (OMFS), effective January 1.
Last week, we detailed changes to reimbursements for E/M services. Today, we take a look at reimbursement changes for surgery. Later this week, we’ll post changes to reimbursements for radiology.
Use the chart below for quick and easy reference.
Surgery Reimbursement Changes
Most surgery services will see a modest increase in reimbursement, from less than a single percent to just under 7 percent. There are two notable exceptions to this trend. Reimbursement for CPT Code 17004 will actually drop in 2018 by 2.64%, from $209.61 to $204.21. Meanwhile, reimbursement for implanting neuroelectrodes (CPT Code 64555) skyrockets by over 83%, from $293.20 to $1762.01, a difference of $1468.81.
The table below features the codes our providers apply most frequently, in ascending order by code number. The data comes complete with a description of the service, the current reimbursement, the 2018 reimbursement, and the difference in both raw price and percentage.
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% |
As mentioned above, we’ll keep our readers informed of all the changes coming to work comp in 2018. Subscribe to the blog, register for our upcoming webinar, and (for those readers who are not DaisyBill clients), feel free to take our OMFS Calculator for a spin with a free trial.
TRY THE OMFS CALCULATOR
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