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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