2022 E/M Reimbursement Rates for CA Workers' Comp - Facility

January 7, 2022 4 min read

By: Catherine Montgomery

2022 E/M Reimbursement Rates for CA Workers' Comp - Facility

California’s Division of Workers’ Compensation recently posted new reimbursement rates for Evaluation and Management (E/M) services. Below we list the new facility reimbursements by county, per the application of Geographic Practice Cost Indices (GPCI).

The rates below apply to all dates of service on or after January 1, 2022.

Make calculating 2022 OMFS reimbursements easy: Try our OMFS Calculator for accurate, instant, always-updated rates (Fee Schedules: California, New York and US DOL).

New 2022 California E/M Reimbursement Rates

There are two tables below; the first table lists the E/M billing codes providers use when treating new patients (CPT 99202-99205). The second table lists the E/M billing codes used when treating established patients (CPT 99211-99215).

The reimbursement rates in this post apply only to facility places of service. For non-facility E/M reimbursement rates, see this post.

The tables list 2022 E/M reimbursements for each county place of service (as determined by the GPCI assigned to the county by Medicare).

For each CPT code, directly below the reimbursement amount (in parentheses), the table lists the percentage difference in payment amount, as compared to the rate for dates of service in 2021; this difference is expressed as a percentage.

Table 1: OMFS Reimbursements Effective 1/1/2022 (Facility)

County

CPT 99202

(% Change)

CPT 99203

(% Change)

CPT 99204

(% Change)

CPT 99205

(% Change)

Alameda and

Contra Costa

$73.74
(1.26%)

$125.01

(1.61%)

$203.69

(1.37%)

$276.96

(1.34%)

Butte

$67.14
(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Fresno

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Imperial

$67.23
(1.28%)

$114.36

(1.80%)

$185.85

(1.45%)

$252.36

(1.40%)

Kern

$68.07

(1.48%)

$115.87

(2.06%)

$188.12

(1.64%)

$255.40

(1.59%)

Kings

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Los Angeles

$70.81

(1.27%)

$120.43

(1.86%)

$195.58

(1.45%)

$265.68

(1.40%)

Madera

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Marin

$73.94

(2.10%)

$125.38

(2.47%)

$204.21

(2.21%)

$277.65

(2.19%)

Merced

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Monterey

$70.03

(1.95%)

$119.05

(2.43%)

$193.57

(2.09%)

$262.90

(2.06%)

Napa

$70.44

(1.27%)

$119.53

(1.66%)

$194.60

(1.39%)

$264.49

(1.36%)

Orange

$70.81

(1.27%)

$120.43
(1.86%)

$195.58

(1.45%)

$265.68

(1.40%)

Sacramento, Placer,

Yolo, El Dorado

$67.92

(1.45%)

$115.50

(1.94%)

$187.75

(1.60%)

$254.95

(1.56%)

San Benito

$76.17

(3.32%)

$129.21

(3.76%)

$210.32

(3.46%)

$285.98

(3.44%)

San Bernardino,

Riverside

$68.63

(1.63%)

$117.01

(2.41%)

$189.58

(1.84%)

$257.34

(1.78%)

San Diego

$69.48

(1.85%)

$118.06

(2.32%)

$191.95

(1.98%)

$260.78

(1.95%)

San Francisco

$73.74

(1.26%)

$125.01

(1.61%)

$203.69

(1.37%)

$276.96

(1.34%)

San Joaquin

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

San Luis Obispo

$67.60

(1.38%)

$114.93

(1.87%)

$186.83

(1.53%)

$253.73

(1.49%)

San Mateo

$73.74

(1.26%)

$125.01

(1.61%)

$203.69

(1.37%)

$276.96

(1.34%)

Santa Barbara

$69.84

(1.96%)

$118.64

(2.42%)

$192.95

(2.09%)

$262.16

(2.06%)

Santa Clara

$75.41

(1.26%)

$127.76

(1.57%)

$208.28

(1.36%)

$283.26

(1.33%)

Santa Cruz

$70.58

(2.11%)

$119.88

(2.58%)

$194.98

(2.24%)

$264.96

(2.22%)

Shasta

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Solano

$70.44

(1.27%)

$119.53

(1.66%)

$194.60

(1.39%)

$264.49

(1.36%)

Sonoma

$70.05

(1.95%)

$119.00

(2.41%)

$193.54

(2.09%)

$262.95

(2.06%)

Stanislaus

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Sutter, Yuba

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Tulare

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Ventura

$69.85

(1.26%)

$118.75

(1.84%)

$192.91

(1.44%)

$262.09

(1.40%)

All Other Counties

$67.14

(1.27%)

$114.18

(1.76%)

$185.59

(1.42%)

$252.02

(1.38%)

Table 2: OMFS Reimbursements Effective 1/1/2022 (Facility)

County

CPT 99211

(% Change)

CPT 99212

(% Change)

CPT 99213

(% Change)

CPT 99214

(% Change)

CPT 99215

(% Change)

Alameda

and

Contra

Costa

$13.53

(1.27%)

$54.41

(2.06%)

$101.11

(1.26%)

$149.22

(0.97%)

$221.08

(1.55%)

Butte

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Fresno

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Imperial

$12.33

(1.23%)

$49.75

(2.47%)

$92.10

(1.29%)

$135.61

(0.86%)

$200.96

(1.54%)

Kern

$12.46

(1.47%)

$50.39

(2.82%)

$93.13

(1.44%)

$137.00

(0.94%)

$203.16

(1.68%)

Kings

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Los Angeles

$12.93

(1.25%)

$52.36

(2.65%)

$96.81

(1.27%)

$142.43

(0.76%)

$211.36

(1.53%)

Madera

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Marin

$13.56

(2.11%)

$54.55

(2.96%)

$101.32

(2.09%)

$149.48

(1.78%)

$221.53

(2.38%)

Merced

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Monterey

$12.85

(1.90%)

$51.79

(3.04%)

$95.96

(1.94%)

$141.37

(1.55%)

$209.46

(2.21%)

Napa

$12.92

(1.25%)

$52.01

(2.18%)

$96.55

(1.27%)

$142.38

(0.93%)

$210.96

(1.54%)

Orange

$12.93

(1.25%)

$52.36

(2.65%)

$96.81

(1.27%)

$142.43

(0.76%)

$211.36

(1.53%)

Sacramento,

Placer,

Yolo, El

Dorado

$12.47

(1.46%)

$50.25

(2.59%)

$93.06

(1.45%)

$137.07
(1.05%)

$203.08

(1.70%)

San Benito

$13.93

(3.26%)

$56.20

(4.34%)

$104.28

(3.32%)

$153.75

(2.97%)

$228.02

(3.64%)

San Bernardino,

Riverside

$12.49

(1.46%)

$50.84

(3.35%)

$93.65

(1.56%)

$137.47

(0.89%)

$204.22

(1.79%)

San Diego

$12.73

(1.84%)

$51.35

(2.97%)

$95.13

(1.82%)

$140.12

(1.41%)

$207.73

(2.10%)

San

Francisco

$13.53

(1.27%)

$54.41

(2.06%)

$101.11

(1.26%)

$149.22

(0.97%)

$221.08

(1.55%)

San Joaquin

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

San Luis

Obispo

$12.40

(1.39%)

$50.00

(2.52%)

$92.60

(1.37%)

$136.39

(0.96%)

$202.11

(1.63%)

San Mateo

$13.53

(1.27%)

$54.41

(2.06%)

$101.11

(1.26%)

$149.22

(0.97%)

$221.08

(1.55%)

Santa

Barbara

$12.80

(1.99%)

$51.61

(3.06%)

$95.65

(1.95%)

$140.92

(1.56%)

$208.89

(2.23%)

Santa Clara

$13.85

(1.32%)

$55.61

(1.98%)

$103.43

(1.26%)

$152.73

(1.01%)

$226.24

(1.55%)

Santa Cruz

$12.93

(2.13%)

$52.15

(3.21%)

$96.66

(2.11%)

$142.42

(1.71%)

$211.14

(2.39%)

Shasta

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Solano

$12.92

(1.25%)

$52.01

(2.18%)

$96.55

(1.27%)

$142.38

(0.93%)

$210.96

(1.54%)

Sonoma

$12.84

(1.99%)

$51.77

(3.05%)

$95.94

(1.94%)

$141.35

(1.55%)

$209.52

(2.22%)

Stanislaus

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Sutter, Yuba

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Tulare

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

Ventura

$12.75

(1.27%)

$51.63

(2.60%)

$95.50

(1.26%)

$140.54

(0.78%)

$208.56

(1.53%)

All Other

Counties

$12.32

(1.23%)

$49.68

(2.41%)

$91.99

(1.27%)

$135.48

(0.85%)

$200.73

(1.51%)

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