2022 Q3 CA OMFS Update: Physician Fee Schedule

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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