2021 Facility E/M Reimbursement Rates for CA Workers' Comp

2021 Facility E/M Reimbursement Rates for CA Workers' Comp

Evaluation and Management (E/M) billing is very different for California workers’ comp physicians in 2021.

Among the changes to the Physician Fee Schedule are new reimbursement rates for existing E/M procedure codes. Previously we provided the new rates for non-facility places of service such as provider offices and urgent care centers. Below are the rates for facility places of service (e.g. hospitals, etc.), as defined by the California Code of Regulations.

E/M Billing in 2021

To understand this year’s significant changes to the rules regarding E/M billing, see our most recent breakdown. Consider also joining our upcoming free live webinar, in which we’ll explore the 2021 Physician Fee Schedule in depth. You’re welcome to submit any specific billing questions during webinar registration, for us to answer during the presentation.

Per the application of Geographic Practice Cost Indices (GPCI), we listed reimbursements for each billing code by county. All reimbursement rates below are effective for dates of service on or after March 1, 2021. Under each price is the percentage difference in reimbursement as compared to the rate for dates of service prior to March 1.

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

  • in a facility,
  • on or after March 1, 2021
  • in Alameda and Contra Costa Counties…

...the reimbursement is $72.82, 1.77% lower than for dates of service prior to March 1.

Table 1: OMFS Facility E/M Reimbursements On or After March 1, 2021

County

CPT 99202

(% Change)

CPT 99203

(% Change)

CPT 99204

(% Change)

CPT 99205

(% Change)

Alameda and

Contra Costa

$72.82

(-1.77%)

$123.03

(11.04%)

$200.94

(5.99%)

$273.29

(10.22%)

Butte

$66.30

(-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Fresno

$66.30

( -1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Imperial

$66.38

 (-1.85%)

$112.34

(10.94%)

$183.20

 (5.76%)

$248.87

 (9.92%)

Kern

$67.08

 (-1.76%)

$113.53

(11.06%)

$185.08

(5.84%)

$251.40

 (10.01%)

Kings

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Los Angeles

$69.92

 (-1.76%)

$118.23

(11.09%)

$192.79

(5.88%)

$262.01

 (10.10%)

Madera

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Marin

$72.42

 (-1.35%)

$122.36

(11.50%)

$199.79

(6.40%)

$271.71

(10.66%)

Merced

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Monterey

$68.69

 (-1.17%)

$116.23

(11.71%)

$189.60

 (6.51%)

$257.60

 (10.71%)

Napa

$69.56

 (-2.69%)

$117.58

(10%)

$191.94

(4.95%)

$260.95

 (9.12%)

Orange

$69.92

 (-1.76%)

$118.23

(11.09%)

$192.79

(5.88%)

$262.01

 (10.10%)

Sacramento, Placer,

Yolo, El Dorado

$66.95

 (-1.65%)

$113.30

(11.17%)

$184.79

(5.98%)

$251.03

 (10.15%)

San Benito

$73.72

(0.14%)

$124.53

(13.15%)

$203.29

(7.97%)

$276.47

 (12.30%)

San Bernardino,

Riverside

$67.53

 (-1.53%)

$114.26

(11.34%)

$186.16

(6.06%)

$252.85

 (10.25%)

San Diego

$68.22

 (-1.33%)

$115.38

(11.53%)

$188.23

(6.36%)

$255.80

 (10.57%)

San Francisco

$72.82

 (-1.77%)

$123.03

(11.04%)

$200.94

(5.99%)

$273.29

 (10.22%)

San Joaquin

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

San Luis Obispo

$66.68

 (-1.61%)

$112.82

(11.20%)

$184.02

(6.02%)

$250.01

 (10.20%)

San Mateo

$72.82

 (-1.77%)

$123.03

(11.04%)

$200.94

(5.99%)

$273.29

 (10.22%)

Santa Barbara

$68.50

 (-1.21%)

$115.84

(11.64%)

$189.00

(6.47%)

$256.86

 (10.69%)

Santa Clara

$74.47

 (-1.14%)

$125.78

(11.72%)

$205.49

(6.67%)

$279.53

 (10.94%)

Santa Cruz

$69.12

 (-1.06%)

$116.87

(11.83%)

$190.70

(6.66%)

$259.20

 (10.89%)

Shasta

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Solano

$69.56

 (-2.69%)

$117.58

 (10%)

$191.94

(4.95%)

$260.95

 (9.12%)

Sonoma

$68.71

 (-1.15%)

$116.20

(11.71%)

$189.58

(6.54%)

$257.64

 (10.76%)

Stanislaus

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Sutter, Yuba

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Tulare

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Ventura

$68.98

 (-1.72%)

$116.6

 (11.11%)

$190.17

(5.93%)

$258.48

 (10.16%)

All Other Counties

$66.30

 (-1.81%)

$112.21

(10.99%)

$183.00

(5.80%)

$248.60

 (9.97%)

Table 2: 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

$13.36

 (-1.84%)

$53.31

 (41.74%)

$99.85

 (32.59%)

$147.78

(27.10%)

$217.71

(32.29%)

Butte

$12.17

 (-1.85%)

$48.51

 (41.18%)

$90.84

 (32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Fresno

$12.17

 (-1.85%)

$48.51

 (41.18%)

$90.84

 (32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Imperial

$12.18

 (-1.85%)

$48.55

 (41.05%)

$90.93

 (32.22%)

$134.46

(26.83%)

$197.92

(32.03%)

Kern

$12.28

 (-1.84%)

$49.01

 (40.95%)

$91.81

 (32.31%)

$135.73

(26.91%)

$199.80

(32.15%)

Kings

$12.17

 (-1.85%)

$48.51

 (41.18%)

$90.84

 (32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Los Angeles

$12.77

 (-1.77%)

$51.01

 (40.87%)

$95.60

 (32.34%)

$141.35

(26.96%)

$208.18

(32.24%)

Madera

$12.17

 (-1.85%)

$48.51

 (41.18%)

$90.84

 (32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Marin

$13.28

 (-1.41%)

$52.98

 (42.19%)

$99.25

 (33.08%)

$146.87

(27.59%)

$216.37

(32.82%)

Merced

$12.17

 (-1.85%)

$48.51

 (41.18%)

$90.84

 (32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Monterey

$12.61

 (-1.18%)

$50.26

 (42.14%)

$94.13

 (33.18%)

$139.21

(27.72%)

$204.93

(32.96%)

Napa

$12.76

 (-2.74%)

$50.90

 (40.22%)

$95.34

 (31.27%)

$141.07

(25.85%)

$207.77

(31.01%)

Orange

$12.77

 (-1.77%)

$51.01

 (40.87%)

$95.60

 (32.34%)

$141.35

(26.96%)

$208.18

(32.24%)

Sacramento,

Placer,

Yolo, El

Dorado

$12.29

 (-1.68%)

$48.98

 (41.40%)

$91.73

 (32.50%)

$135.65

(27.07%)

$199.68

(32.29%)

San Benito

$13.49

 (0.07%)

$53.86

 (44.01%)

$100.93

(35.01%)

$149.32

(29.48%)

$220.01

(34.84%)

San Bernardino,

Riverside

$12.31

(-1.60%)

$49.19

 (40.74%)

$92.21

(32.49%)

$136.26

(27.13%)

$200.62

(32.45%)

San Diego

$12.50

(-1.34%)

$49.87

 (41.80%)

$93.43

 (33%)

$138.17

(27.55%)

$203.46

(32.81%)

San

Francisco

$13.36

(-1.84%)

$53.31

 (41.74%)

$99.85

(32.59%)

$147.78

(27.10%)

$217.71

(32.29%)

San Joaquin

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

San Luis

Obispo

$12.23

(-1.69%)

$48.77

 (41.44%)

$91.35

(32.56%)

$135.09

(27.12%)

$198.87

(32.35%)

San Mateo

$13.36

(-1.84%)

$53.31

 (41.74%)

$99.85

(32.59%)

$147.78

(27.10%)

$217.71

(32.29%)

Santa

Barbara

$12.55

(-1.34%)

$50.08

 (41.99%)

$93.82

(33.12%)

$138.76

(27.67%)

$204.34

(32.93%)

Santa Clara

$13.67

(-1.23%)

$54.53

 (42.75%)

$102.14

(33.45%)

$151.20

(27.92%)

$222.78

(33.14%)

Santa Cruz

$12.66

(-1.17%)

$50.53

 (42.26%)

$94.66

(33.34%)

$140.02

(27.90%)

$206.21

(33.17%)

Shasta

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Solano

$12.76

(-2.74%)

$50.90

 (40.22%)

$95.34

(31.27%)

$141.07

(25.85%)

$207.77

(31.01%)

Sonoma

$12.59

(-1.25%)

$50.24

 (42.12%)

$94.11

(33.21%)

$139.19

(27.74%)

$204.97

(33.01%)

Stanislaus

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Sutter, Yuba

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

134.34

(26.87%)

$197.74

(32.07%)

Tulare

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

Ventura

$12.59

(-1.79%)

$50.32

 (40.95%)

$94.31

(32.40%)

$139.45

(27.03%)

$205.41

(32.30%)

All Other

Counties

$12.17

(-1.85%)

$48.51

 (41.18%)

$90.84

(32.28%)

$134.34

(26.87%)

$197.74

(32.07%)

As California’s Division of Workers’ Compensation (DWC) adopts further updates, we’ll keep our readers informed in this space. Again, we are happy to answer any questions regarding the 2021 Physician Fee Schedule at this week’s live webinar.


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