California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation, effective for all dates of service on or after April 1, 2022.  

The update adds 30 new procedure codes, alters the status of three existing procedure codes without affecting reimbursement amounts, and alters reimbursement for one existing procedure code.

The update conforms the OMFS to relevant 2022 second quarter changes to the Centers for Medicare and Medicaid Services (CMS) payment system, as required by California Labor Code Section 5307.1. The DWC announced the update in a recent Newsline, and posted the order adopting the update on the DWC website.

Read on for details.

30 New HCPCS Codes

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) beginning April 2022. All 30 of the new procedure codes are billable By Report (BR).

California Code of Regulations Section 9789.12.4 offers guidelines to determine appropriate reimbursement amounts for BR codes; essentially, providers find a comparable procedure in terms of time, skill, and resources required, and charge accordingly. The provider must justify the amount charged with a separate (non-reimbursable) report.

2022 New HCPCS Codes for CA Workers’ Comp Physician Services

Status Codes Altered

In addition to the above changes, the DWC update alters the Status Codes of three existing procedure codes; however, these codes remain billable By Report.

Procedure Code Now Reimbursable By Report

The DWC update renders HCPCS 76390 for “Mr spectroscopy” billable By Report; previously, the Physician Fee Schedule established a set reimbursement rate. HCPCS 76390 remains billable By Report when used in conjunction with modifiers -TC and -26.

Additionally, providers may note that the 2022 Q2 update does not include a new telehealth procedure code list. Existing procedures deliverable via telehealth remain the same.

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