2022 Q3 CA OMFS Update: Physician Fee Schedule

June 30, 2022 4 min read

By: the daisyNews Team

2022 Q3 CA OMFS Update: Physician Fee Schedule

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 July 1, 2022.

The update adds 55 new procedure codes, all reimbursable “By Report.” The update also alters the status of 3 existing procedure codes, without affecting reimbursement amounts.

The update conforms the OMFS to relevant 2022 third 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.

55 New HCPCS Codes

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) beginning July 2022. All 55 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.

New HCPCS Codes for CA Workers’ Comp Physician Services

HCPCS	Modifier	Description	Reimbursement
A9596		Gallium illuccix 1 millicure	By Report
A9601		Flortaucipir inj 1 millicuri	By Report
D1708		Pfizer vacc admin 3rd dose	By Report
D1709		Pfizer vaccine admin booster	By Report
D1710		Moderna vacc admin 3rd dose	By Report
D1711		Moderna vacc admin booster	By Report
D1712		Janssen vacc admin booster	By Report
D1713		Pfizer vacc adm ped 1st dose	By Report
D1714		Pfizer vacc adm ped 2nd dose	By Report
G0308		180 d implant glucose sensor	By Report
G0309		Rem/inseráglu sensor dif sit	By Report
J0739		Injection, cabotegravir, 1 m	By Report
J1306		Injection, inclisiran, 1 mg	By Report
J1551		Inj cutaquig 100 mg	By Report
J2356		Inj tezepelumab-ekko, 1mg	By Report
J2779		Inj, susvimo 0.1 mg	By Report
J2998		Inj plasminogen tvmh 1mg	By Report
J3299		Inj xipere 1 mg	By Report
J9331		Inj sirolimus prot part 1 mg	By Report
J9332		Inj efgartigimod 2mg	By Report
M0222		Bebtelovimab injection	By Report
M0223		Bebtelovimab injection home	By Report
Q0221		Tixagev and cilgav, 600mg	By Report
Q0222		Bebtelovimab 175 mg	By Report
Q4259		Celera per sq cm	By Report
Q4260		Signature apatch, per sq cm	By Report
Q4261		Tag, per square centimeter	By Report
0094A		Adm sarscov2 50 mcg/.5 mlbs	By Report
0398T	TC	Mrgfus strtctc les abltj	By Report
0398T	26	Mrgfus strtctc les abltj	By Report
0714T		Tprnl lsr ablt b9 prst8 hypr	By Report
0715T		Perq trluml coronry lithotrp	By Report
0716T		Car acous wavfrm rec cad rsk	By Report
0717T		Adrc ther prtl rc tear	By Report
0718T		Adrc ther prtl rc tear njx	By Report
0719T		Pst vrt jt rplcmt lmbr 1 sgm	By Report
0720T		Prq elc nrv stim cn wo implt	By Report
0721T		Quan ct tiss charac w/o ct	By Report
0721T	TC	Quan ct tiss charac w/o ct	By Report
0721T	26	Quan ct tiss charac w/o ct	By Report
0722T		Quan ct tiss charac w/ct	By Report
0722T	TC	Quan ct tiss charac w/ct	By Report
0722T	26	Quan ct tiss charac w/ct	By Report
0723T		Qmrcp w/o dx mri sm anat ses	By Report
0723T	TC	Qmrcp w/o dx mri sm anat ses	By Report
0723T	26	Qmrcp w/o dx mri sm anat ses	By Report
0724T		Qmrcp w/dx mri same anatomy	By Report
0724T	TC	Qmrcp w/dx mri same anatomy	By Report
0724T	26	Qmrcp w/dx mri same anatomy	By Report
0725T		Vestibular dev impltj uni	By Report
0726T		Rmvl implt vstibular dev uni	By Report
0727T		Rmvl&rplcmt implt vstblr dev	By Report
0728T		Dx alys vstblr implt uni 1st	By Report
0729T		Dx alys vstblr implt uni sbq	By Report
0730T		Trabeculotomy lsr w/oct gdn	By Report
0731T		Augmnt ai-based fcl phnt a/r	By Report
0732T		Immntx admn electroporatn im	By Report
0733T		Rem bdy&lmb knmtc ther sply	By Report
0734T		Rem bdy&lmb knmtc tx mgmt	By Report
0735T		Prep tum cav iort prim crnot	By Report
0736T		Colonic lavage 35+l water	By Report
0737T		Xenograft impltj artclr surf	By Report
87913		Nfct agt gntyp alys sarscov2	By Report
90584		Dengue vacc quad 2 dose subq	By Report
91309		Sarscov2 vac 50mcg/0.5ml im	By Report

Status Codes Altered

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

HCPCS	Description	Change
A9574	Air poly intrauterine foam	Status Code change only. Remains "By Report."
G1009	Cdsm sage health	Status Code change only. Remains "By Report."
M1145	Mfn drug add-on, per dose	Status Code change only. Remains "By Report."

Additionally, providers may note that the 2022 Q3 update includes a new telehealth procedure code list.

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