2019 CA Workers’ Comp Evaluation & Management Cheat Sheet
The 2019 changes to California’s reimbursements got your head spinning? Here’s a handy reimbursement cheat sheet for the most frequently used Evaluation & Management codes.
Use this to start grappling with Medicare Geographic Practice Cost Indices (GPCIs), newly implemented for the workers’ comp Official Medical Fee Schedule (OMFS) as of 1/1/2019.
The tables below compare the 2019 reimbursement to the previous 2018 reimbursement for seven of the most popular Evaluation and Management codes. Depending on the location where services are provided to the injured worker, the adoption of Medicare GPCIs results in a reduced 2019 reimbursement for some providers while increasing the reimbursement for other providers.
As a reminder, with the adoption of location-based reimbursement, effective for all dates of service on or after 1/1/2019, California no longer reimburses providers using a single state-wide geographic adjustment factor (GAF). Instead, the reimbursement calculation now uses three location-based GPCIs (PW, PE, MP) assigned by Medicare to the place of service.
We organized the comparison table from the lowest to highest reimbursement areas. This organization gives you an idea as to where you stand relative to the rest of the state.
As a bonus, we put the 2018 baseline rates in the middle to illustrate the cutoff between areas with reduced rates and those with increased rates. For localities above the 2018 reimbursement line for each code, 2019 reimbursements are less than 2018 reimbursements. For localities below the 2018 reimbursement line for each code, then 2019 reimbursements are more than 2018 reimbursements.
These OMFS reimbursements are effective for dates of service on or after January 1, 2019, and are representative of all the 32 distinct geographic regions delineated by the new GPCI methodology.
2019 Reimbursements for Office/Outpatient Visit - New
Place of Service County |
2019 vs 2018 OMFS Reimbursement |
99203 Non Facility |
99204 Non Facility |
99205 Non Facility |
CHICO |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
FRESNO |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
MADERA |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
MERCED |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
MODESTO |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
REDDING |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
STOCKTON-LODI |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
VISALIA-PORTERVILLE |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
YUBA CITY |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
REST OF STATE* |
OMFS Reduction |
$143.39 |
$217.05 |
$272.41 |
EL CENTRO |
OMFS Reduction |
$143.44 |
$217.13 |
$272.51 |
HANFORD-CORCORAN |
OMFS Reduction |
$143.45 |
$217.16 |
$272.55 |
BAKERSFIELD |
OMFS Reduction |
$143.75 |
$217.59 |
$273.10 |
SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE |
OMFS Reduction |
$144.07 |
$217.96 |
$273.50 |
RIVERSIDE-SAN BERNARDINO-ONTARIO |
OMFS Reduction |
$144.68 |
$219.00 |
$274.92 |
SACRAMENTO--ROSEVILLE--ARDEN-ARCADE |
OMFS Reduction |
$145.07 |
$219.47 |
$275.39 |
SALINAS |
OMFS Reduction |
$145.62 |
$220.18 |
$276.23 |
SAN DIEGO-CARLSBAD |
OMFS Reduction |
$146.50 |
$221.29 |
$277.53 |
SANTA ROSA |
OMFS Reduction |
$147.47 |
$222.60 |
$279.10 |
SANTA MARIA-SANTA BARBARA |
OMFS Reduction |
$147.72 |
$223.13 |
$279.83 |
2018 REIMBURSEMENT |
$149.04 |
$225.94 |
$283.28 |
|
SANTA CRUZ-WATSONVILLE |
OMFS Increase |
$149.98 |
$226.10 |
$283.36 |
OXNARD-THOUSAND OAKS-VENTURA |
OMFS Increase |
$151.33 |
$227.87 |
$285.50 |
LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY) |
OMFS Increase |
$152.96 |
$230.62 |
$289.06 |
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY) |
OMFS Increase |
$152.96 |
$230.62 |
$289.06 |
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) |
OMFS Increase |
$155.04 |
$233.39 |
$292.34 |
NAPA |
OMFS Increase |
$157.43 |
$236.55 |
$296.07 |
VALLEJO-FAIRFIELD |
OMFS Increase |
$157.43 |
$236.55 |
$296.07 |
SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY) |
OMFS Increase |
$160.48 |
$240.86 |
$301.34 |
OAKLAND/BERKLEY |
OMFS Increase |
$163.21 |
$244.72 |
$306.05 |
SAN FRANCISCO |
OMFS Increase |
$163.21 |
$244.72 |
$306.05 |
SAN MATEO |
OMFS Increase |
$163.21 |
$244.72 |
$306.05 |
SANTA CLARA |
OMFS Increase |
$165.50 |
$247.94 |
$309.97 |
2019 Reimbursements for Office/Outpatient Visit - Established
Place of Service County |
2019 vs 2018 OMFS Reimbursement |
99212 Non Facility |
99213 Non Facility |
99214 Non Facility |
99215 Non Facility |
CHICO |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
FRESNO |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
MADERA |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
MERCED |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
MODESTO |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
REDDING |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
STOCKTON-LODI |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
VISALIA-PORTERVILLE |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
YUBA CITY |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
REST OF STATE* |
OMFS Reduction |
$60.41 |
$98.87 |
$144.62 |
$193.15 |
EL CENTRO |
OMFS Reduction |
$60.42 |
$98.90 |
$144.66 |
$193.21 |
HANFORD-CORCORAN |
OMFS Reduction |
$60.43 |
$98.92 |
$144.69 |
$193.25 |
BAKERSFIELD |
OMFS Reduction |
$60.51 |
$99.05 |
$144.88 |
$193.54 |
SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE |
OMFS Reduction |
$60.75 |
$99.35 |
$145.29 |
$193.99 |
RIVERSIDE-SAN BERNARDINO-ONTARIO |
OMFS Reduction |
$60.78 |
$99.53 |
$145.57 |
$194.56 |
SACRAMENTO--ROSEVILLE--ARDEN-ARCADE |
OMFS Reduction |
$61.18 |
$100.05 |
$146.31 |
$195.35 |
SALINAS |
OMFS Reduction |
$61.47 |
$100.44 |
$146.84 |
$196.01 |
2018 REIMBURSEMENT |
$61.67 |
||||
SAN DIEGO-CARLSBAD |
$61.93 |
$101.05 |
$147.68 |
$197.04 |
|
2018 REIMBURSEMENT |
$101.39 |
||||
SANTA ROSA |
$62.42 |
$101.74 |
$148.64 |
$198.26 |
|
SANTA MARIA-SANTA BARBARA |
$62.46 |
$101.91 |
$148.93 |
$198.70 |
|
2018 REIMBURSEMENT |
$149.32 |
$200.52 |
|||
SANTA CRUZ-WATSONVILLE |
OMFS Increase |
$63.62 |
$103.50 |
$151.13 |
$201.46 |
OXNARD-THOUSAND OAKS-VENTURA |
OMFS Increase |
$64.21 |
$104.32 |
$152.23 |
$202.91 |
LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY) |
OMFS Increase |
$64.76 |
$105.41 |
$153.91 |
$205.26 |
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY) |
OMFS Increase |
$64.76 |
$105.41 |
$153.91 |
$205.26 |
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) |
OMFS Increase |
$65.93 |
$107.03 |
$156.19 |
$208.06 |
NAPA |
OMFS Increase |
$67.25 |
$108.86 |
$158.74 |
$211.18 |
VALLEJO-FAIRFIELD |
OMFS Increase |
$67.25 |
$108.86 |
$158.74 |
$211.18 |
SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY) |
OMFS Increase |
$68.67 |
$110.99 |
$161.77 |
$215.10 |
OAKLAND/BERKLEY |
OMFS Increase |
$69.99 |
$112.95 |
$164.56 |
$218.68 |
SAN FRANCISCO |
OMFS Increase |
$69.99 |
$112.95 |
$164.56 |
$218.68 |
SAN MATEO |
OMFS Increase |
$69.99 |
$112.95 |
$164.56 |
$218.68 |
SANTA CLARA |
OMFS Increase |
$71.10 |
$114.59 |
$166.90 |
$221.67 |
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