2020 CA Workers’ Comp Evaluation & Management Cheat Sheet

2020 CA Workers’ Comp Evaluation & Management Cheat Sheet

Hooray! In 2020 reimbursements increased across the board for Evaluation & Management (E&M) codes!

Below we’ve compiled a nifty reimbursement cheat sheet for the seven most frequently used E&M codes, with tables for both new and established patients.

Reminder: since 1/1/2019, California no longer reimburses providers using a single state-wide geographic adjustment factor (GAF). Instead, with the adoption of geographic practice cost indices (GPCIs) the reimbursement calculation now uses three location-based GPCIs (PW, PE, MP) assigned by Medicare.

The adoption of Medicare GPCIs results in a variable reimbursement for providers depending on the location where services are provided to the injured worker.

We organized the tables from the lowest to highest reimbursement areas to give you an idea as to where you stand relative to the rest of the state.

These OMFS reimbursements are effective for dates of service on or after January 1, 2020.

2020 Reimbursements for Office/Outpatient Visit - New

Place of Service County

99203
Non Facility

99204
Non Facility

99205
Non Facility

Butte

$145.66

$221.52

$279.63

Fresno

$145.66

$221.52

$279.63

Kings

$145.66

$221.52

$279.63

Madera

$145.66

$221.52

$279.63

Merced

$145.66

$221.52

$279.63

San Joaquin

$145.66

$221.52

$279.63

Shasta

$145.66

$221.52

$279.63

Stanislaus

$145.66

$221.52

$279.63

Sutter, Yuba

$145.66

$221.52

$279.63

Tulare

$145.66

$221.52

$279.63

All Other Counties

$145.66

$221.52

$279.63

Imperial

$145.81

$221.79

$279.98

San Luis Obispo

$145.56

$222.73

$281.09

Sacramento, Placer, Yolo, El Dorado

$146.81

$223.29

$281.87

Kern

$146.78

$223.43

$282.09

San Bernardino, Riverside

$147.18

$224.10

$282.91

Monterey

$150.36

$228.48

$288.36

San Diego

$150.51

$228.27

$287.91

Santa Barbara

$151.23

$229.26

$289.13

Sonoma

$151.57

$229.79

$289.80

Santa Cruz

$152.82

$231.45

$291.82

Ventura

$154.00

$232.99

$293.63

Los Angeles

$155.41

$235.45

$296.85

Orange

$155.41

$235.45

$296.85

Napa

$158.44

$239.07

$301.11

Solano

$158.44

$239.07

$301.11

San Benito

$163.32

$246.34

$310.22

Marin

$163.84

$246.72

$310.58

Alameda & Contra Costa

$166.06

$249.80

$314.37

San Francisco

$166.06

$249.80

$314.37

San Mateo

$166.06

$249.80

$314.37

Santa Clara

$169.59

$254.77

$320.51

2020 Reimbursements for Office/Outpatient Visit - Established

Place of Service County

99212
Non Facility

99213
Non Facility

99214
Non Facility

99215
Non Facility

Butte

$61.90

$101.71

$147.44

$197.78

Fresno

$61.90

$101.71

$147.44

$197.78

Kings

$61.90

$101.71

$147.44

$197.78

Madera

$61.90

$101.71

$147.44

$197.78

Merced

$61.90

$101.71

$147.44

$197.78

San Joaquin

$61.90

$101.71

$147.44

$197.78

Shasta

$61.90

$101.71

$147.44

$197.78

Stanislaus

$61.90

$101.71

$147.44

$197.78

Sutter, Yuba

$61.90

$101.71

$147.44

$197.78

Tulare

$61.90

$101.71

$147.44

$197.78

All Other Counties

$61.90

$101.71

$147.44

$197.78

Imperial

$61.96

$101.81

$147.58

$197.97

San Luis Obispo

$62.36

$102.36

$148.33

$198.91

Sacramento, Placer, Yolo, El Dorado

$62.38

$102.52

$148.62

$199.36

Kern

$62.31

$102.44

$148.51

$199.25

San Bernardino, Riverside

$62.48

$102.65

$148.73

$199.54

Monterey

$63.98

$105.02

$152.19

$204.08

San Diego

$64.25

$105.15

$152.22

$203.96

Santa Barbara

$64.60

$105.68

$152.97

$204.93

Sonoma

$64.74

$105.92

$153.31

$205.40

Santa Cruz

$65.37

$106.81

$154.53

$206.96

Ventura

$66.01

$107.61

$155.53

$208.17

Los Angeles

$66.47

$108.55

$157.00

$210.25

Orange

$66.47

$108.55

$157.00

$210.25

Napa

$68.16

$110.86

$160.16

$214.20

Solano

$68.16

$110.86

$160.16

$214.20

San Benito

$70.31

$114.26

$164.99

$220.61

Marin

$70.69

$114.70

$165.56

$221.25

Alameda & Contra Costa

$71.76

$116.29

$167.81

$224.18

San Francisco

$71.76

$116.29

$167.81

$224.18

San Mateo

$71.76

$116.29

$167.81

$224.18

Santa Clara

$73.43

$118.82

$171.37

$228.83

For more information about updates to E&M reimbursements and major changes to the OMFS, check out DaisyBill’s 2020 CA OMFS Overview Webinar!

WATCH THE WEBINAR

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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.

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