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2021 E/M Reimbursement Rates for CA Workers' Comp

2021 E/M Reimbursement Rates for CA Workers' Comp

As we reported previously, California’s Division of Workers’ Compensation made major changes to Evaluation and Management (E/M) billing for 2021.

In addition to updating the billing and coding rules, the DWC posted new reimbursement rates for E/M services. Below, we listed the new reimbursements by county, per the application of Geographic Practice Cost Indices (GPCI). The rates below apply to all dates of service on or after March 1, 2021.

Comparing E/M Reimbursement Rates

There are two tables below: one featuring the E/M billing codes providers use for new patients (CPT 99202-99205), and one with codes for established patients (CPT 99211-99215). The rates in this post are for non-facilities only. We will publish another post with facility rates in the very near future.

For each county, reimbursements are listed for each billing code. Under the reimbursement, (in parentheses) is the difference in payment as compared to the rates for dates of service prior to March 1. The difference is expressed as a percentage.

For an example, see the first line of Table 1. Reimbursement for CPT 99202:

  • for services delivered on or after March 1,
  • in a non-facility,
  • in Alameda and Contra Costa Counties...

...is $114.89 The new reimbursement is 2.81% lower compared to the pre-March 1 reimbursement of $118.21.

Table 1: OMFS Non-Facility E/M Reimbursements On or After March 1, 2021 (New Patients)

County

CPT 99202

(% Change)

CPT 99203

(% Change)      

CPT 99204

(% Change)

CPT 99205

(% Change)

Alameda and

Contra Costa

$114.89

(-2.81%)

$174.24

(4.93%)

$257.63  

(3.13%)

$339.13

 (7.88%)

Butte

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43  

(3.12%)

$301.35

 (7.77%)

Fresno

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Imperial

$100.09

(-2.99%)

$153.37

(5.18%)

$228.63

(3.08%)

$301.63

 (7.73%)

Kern

$100.79

(-2.93%)

$154.57

(5.31%)

$230.52

(3.17%)

$304.16

 (7.82%)

Kings

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Los Angeles

$107.11

(-2.84%)

$163.5

(5.21%)

$242.92

(3.17%)

$320.22

 (7.87%)

Madera

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Marin

$113.91

(-2.28%)

$172.87

(5.51%)

$255.72

(3.65%)

$336.66

 (8.40%)

Merced

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Monterey

$104.21

(-2.10%)

$159.47

(6.06%)

$237.46

(3.93%)

$313.18

 (8.61%)

Napa

$108.17

(-3.94%)

$164.59

(3.88%)

$243.98

(2.05%)

$321.39

 (6.74%)

Orange

$107.11

(-2.84%)

$163.5

(5.21%)

$242.92

(3.17%)

$320.22

 (7.87%)

Sacramento, Placer,

Yolo, El Dorado

$101.10

(-2.68%)

$154.87

(5.49%)

$230.82

(3.37%)

$304.48

 (8.02%)

San Benito

$115.81

(-0.26%)

$175.78

(7.63%)

$260.03

(5.56%)

$342.35

(10.36%)

San Bernardino,

Riverside

$101.24

(-2.77%)

$155.3

(5.52%)

$231.59

(3.34%)

$305.61

 (8.02%)

San Diego

$104.46

(-2.08%)

$159.50

(5.97%)

$237.07

(3.86%)

$312.52

 (8.55%)

San Francisco

$114.89

(-2.81%)

$174.24

(4.93%)

$257.63

(3.13%)

$339.13

 (7.88%)

San Joaquin

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

San Luis Obispo

$101.02

(-2.63%)

$154.63

(5.51%)

$230.30

(3.40%)

$303.76

 (8.07%)

San Mateo

$114.89

(-2.81%)

$174.24

(4.93%)

$257.63

(3.13%)

$339.13

 (7.88%)

Santa Barbara

$105.12

(-1.96%)

$160.42

(6.08%)

$238.35

(3.96%)

$314.18

 (8.66%)

Santa Clara

$118.24

(-2.13%)

$179.07

(5.59%)

$264.49

(3.82%)

$348.05

 (8.59%)

Santa Cruz

$106.50

(-1.75%)

$162.38

(6.26%)

$241.08

(4.16%)

$317.70

 (8.87%)

Shasta

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Solano

$108.17

(-3.94%)

$164.59

(3.88%)

$243.98

(2.05%)

$321.39

 (6.74%)

Sonoma

$105.39

(-1.92%)

$160.85

(6.12%)

$239.02

(4.02%)

$315.06

 (8.72%)

Stanislaus

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Sutter, Yuba

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Tulare

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Ventura

$106.29

(-2.77%)

$162.03

(5.21%)

$240.46

(3.21%)

$316.89

 (7.92%)

All Other Counties

$100.01

(-2.97%)

$153.24

(5.20%)

$228.43

(3.12%)

$301.35

 (7.77%)

Table 2: Non-Facility E/M Reimbursements On or After March 1, 2021 (Established Patients)

County

CPT 99211

(% Change)

CPT 99212

(% Change)

CPT 99213

(% Change)

CPT 99214

(% Change)

CPT 99215

(% Change)

Alameda and

Contra Costa

$37.75

(-0.19%)

$89.27 (24.40%)

$142.52 (22.56%)

$201.42 (20.03%)

$279.29 (24.58%)

Butte

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

$177.32 (20.27%)

$247.08 (24.93%)

Fresno

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

$177.32 (20.27%)

$247.08 (24.93%)

Imperial

$31.72

(-0.66%)

$77.37

(24.87%)

$125.13

(22.91%)

$177.45 (20.24%)

$247.26 (24.90%)

Kern

$31.82

(-0.66%)

$77.83

(24.91%)

$126.01

(23.01%)

$178.72

(20.34%)

$249.14

(25.04%)

Kings

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

$177.32 (20.27%)

$247.08 (24.93%)

Los Angeles

$34.33 (-0.38%)

$82.81 (24.58%)

$133.33 (22.83%)

$188.78 (20.24%)

$262.62 (24.91%)

Madera

$31.71

(-0.66%)

$77.33 (24.93%)

$133.33 (22.94%)

$177.32 (20.27%)

$247.08 (24.93%)

Marin

$37.33

(-0.43%)

$88.46 (25.14%)

$141.34 (23.23%)

$199.79 (20.68%)

$277.11

(25.25%)

Merced

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

$177.32 (20.27%)

$247.08 (24.93%)

Monterey

$33.19 (-0.42%)

$80.63 (26.02%)

$130.16 (23.94%)

$184.5

(21.23%)

$256.92 (25.89%)

Napa

$35.15

(-1.57%)

$83.92 (23.12%)

$134.51

(21.33%)

$190.31

(18.82%)

$264.29 (23.38%)

Orange

$34.33 (-0.38%)

$82.81 (24.58%)

$133.33 (22.83%)

$188.78 (20.24%)

$262.62 (24.91%)

Sacramento, Placer,

Yolo, El Dorado

$32.08 (-0.28%)

$78.18

(25.33%)

$126.38 (23.27%)

$179.21 (20.58%)

$249.67 (25.24%)

San Benito

$37.89

(2.91%)

$89.86

(27.81%)

$143.63

(25.70%)

$203.01 (23.04%)

$281.63

(27.66%)

San Bernardino,

Riverside

$31.85

(-0.59%)

$78.02 (24.87%)

$126.41

(23.15%)

$179.24 (20.51%)

$249.96 (25.27%)

San Diego

$33.51

(0.66%)

$80.86 (25.85%)

$130.19

(23.81%)

$184.39

(21.13%)

$256.51 (25.76%)

San Francisco

$37.75

(-0.19%)

$89.27 (24.40%)

$142.52 (22.56%)

201.42

(20.03%)

$279.29 (24.58%)

San Joaquin

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

San Luis Obispo

$32.14

(-0.19%)

$78.14

(25.30%)

$126.19 (23.28%)

178.88

(20.60%)

$249.13 (25.25%)

San Mateo

$37.75

(-0.19%)

$89.27 (24.40%)

$142.52 (22.56%)

201.42

(20.03%)

$279.29 (24.58%)

Santa Barbara

$33.78

(0.78%)

$81.4

(26.01%)

$130.97 (23.93%)

185.47

(21.25%)

$257.94 (25.87%)

Santa Clara

$39.05

(0.59%)

$91.96 (25.23%)

$146.55 (23.34%)

207.02

(20.80%)

$286.85 (25.36%)

Santa Cruz

$34.33

(1.03%)

$82.49 (26.19%)

$132.58 (24.13%)

187.69

(21.46%)

$260.92 (26.07%)

Shasta

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

Solano

$35.15

(-1.57%)

$83.92 (23.12%)

$134.51

(21.33%)

190.31

(18.82%)

$264.29 (23.38%)

Sonoma

$33.86

(0.80%)

$81.61

(26.06%)

$131.32 (23.98%)

185.98

(21.31%)

$258.66 (25.93%)

Stanislaus

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

Sutter, Yuba

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

Tulare

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

Ventura

$34.23

(-0.26%)

$82.23 (24.57%)

$132.17 (22.82%)

187.04

(20.26%)

$260.03 (24.91%)

All Other

Counties

$31.71

(-0.66%)

$77.33 (24.93%)

$125.04 (22.94%)

177.32

(20.27%)

$247.08 (24.93%)

For dates of service prior to March 1, providers continue to apply Centers for Medicare and Medicaid Services (CMS) 1995 or 1997 Documentation Guidelines for E/M Services.

DaisyBill will host a free webinar exploring the latest updates to California’s Physician Fee Schedule in detail. Consider joining us, and feel free to submit any questions during registration. We hope to see you there.


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