2024 CA Physician Fee Schedule Changes

February 2, 2024 24 min read

By: the daisyNews Team

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 February 15, 2024.

The update aligns the OMFS to relevant 2024 changes in the Medicare payment system, as required by California Labor Code Section 5307.1.

The DWC announced the update in a Newsline and posted the adoption order on its website. Read on for details!

The 2024 Physician Fee Schedule update includes five substantive changes:

An increased Conversion Factor used to calculate California Physician Fee Schedule reimbursement rates
California-Specific Codes increased reimbursements
653 HCPCS reimbursement changes as detailed below
Merging of three counties for GPCI calculations
New telehealth billing requirements

The daisyBill 2024 webinar will touch upon these five substantive changes to the Physician Fee Schedule.

In the meantime, the following two changes are discussed: 1) The Conversion Factor change and 2) The 653 HCPCS reimbursement changes.

Conversion Factor Increased

Calculating reimbursement rates for physician services first requires determining the “Base Maximum Fee” before applying other fee-affecting modifiers or rules. Under the current fee schedule, based on the Centers for Medicare and Medicaid Services’ (CMS) Resource-Based Relative Value Scale (RBRVS), the Base Maximum Fee is calculated using three factors:

Relative Value Units (RVUs) as determined by Medicare
Geographic Practice Cost Index (GPCI) as determined by Medicare
Conversion Factor (CF) as determined by the California DWC

The Conversion Factor used to calculate OMFS reimbursements for physician services is increasing from $47.21 to $47.72; the OMFS will pay 145.74% of Medicare rates for the same services.

With this Conversion Factor increase, the DWC acknowledges that treating injured workers requires about 45% more work than treating a Medicare patient — though California still allows PPOs to drastically reduce reimbursement rates to well below OMFS (and sometimes even below Medicare) rates.

HCPCS: 14 Reimbursement Calculation Altered

Besides the above Conversion Factor change, 14 existing procedure codes formerly bundled or billable only “By Report” now have established reimbursement amounts as detailed in the table below.

HCPCS	Description	Reimbursement Calculation
22860	Tot disc arthrp 2ntrspc lmbr	RVU+GPCI+CF
96202	Mlt fam grp bhv train 1st 60	RVU+GPCI+CF
96203	Mlt fam grp bhv train ea add	RVU+GPCI+CF
A6530	Compression stocking bk18-30	Section 9789.60 establishes payment conditions
A6533	Gc stocking thighlngth 18-30	Section 9789.60 establishes payment conditions
A6534	Gc stocking thighlngth 30-40	Section 9789.60 establishes payment conditions
A6535	Gc stocking thighlngth 40+	Section 9789.60 establishes payment conditions
A6536	Gc stocking full lngth 18-30	Section 9789.60 establishes payment conditions
A6537	Gc stocking full lngth 30-40	Section 9789.60 establishes payment conditions
A6538	Gc stocking full lngth 40+	Section 9789.60 establishes payment conditions
A6539	Gc stocking waistlngth 18-30	Section 9789.60 establishes payment conditions
A6540	Gc stocking waistlngth 30-40	Section 9789.60 establishes payment conditions
A6541	Gc stocking waistlngth 40+	Section 9789.60 establishes payment conditions
G2211	Complex e/m visit add on	RVU+GPCI+CF

HCPCS: 485 New Codes & 154 Deleted Codes

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for 2024, as well as HCPCS the DWC deleted from the California Physician Fee Schedule.

Note that when Medicare fails to assign an HCPCS code a Relative Value Unit (RVU), the reimbursement is calculated “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.

495 New HCPCS Added to Physician Services Fee Schedule

HCPCS	Modifier	Description	Reimbursement Calculation
22836		Ant thrc vrt body tethrg <7	RVU+GPCI+CF
22837		Ant thrc vrt body tethrg 8+	RVU+GPCI+CF
22838		Rev rplc/rmv thrc vrt tethrg	RVU+GPCI+CF
27278		Arthrd si jt prq wo tfxj dev	RVU+GPCI+CF
31242		Nsl/sinus ndsc rf abltj pnn	RVU+GPCI+CF
31243		Nsl/sinus ndsc cryoabltj pnn	RVU+GPCI+CF
33276		Insj phrnc nrv stim sys	RVU+GPCI+CF
33277		Insj phrnc nrv stim transvns	RVU+GPCI+CF
33278		Rmvl phrnc nrv stim sys	RVU+GPCI+CF
33279		Rmvl phrnc nrv stim transvns	RVU+GPCI+CF
33280		Rmvl phrnc nrv stim pg only	RVU+GPCI+CF
33281		Reposg phrnc nrv stim trnsvn	RVU+GPCI+CF
33287		Rmv&rplcmt phrnc nrv stim pg	RVU+GPCI+CF
33288		Rmv&rplcmt phrnc nrv stim ld	RVU+GPCI+CF
52284		Cysto rx balo cath urtl strx	RVU+GPCI+CF
58580		Transcrv abltj utrn fibrd rf	RVU+GPCI+CF
61889		Ins sk-mnt crnl nstm pg/rcvr	RVU+GPCI+CF
61891		Rev/rplcmt sk-mnt crnl nstm	RVU+GPCI+CF
61892		Rmv sk-mnt crnl nstm pg/rcvr	RVU+GPCI+CF
64596		Ins/rplcmt prq eltrd ra pn 1	By Report
64597		Ins/rplcm prq eltrd ra pn ea	By Report
64598		Revj/rmvl nea pn w/int nstim	By Report
67516		Sprchoroidal spc njx rx agt	RVU+GPCI+CF
75580	TC	N-invas est c ffr sw aly cta	RVU+GPCI+CF
75580	26	N-invas est c ffr sw aly cta	RVU+GPCI+CF
75580		N-invas est c ffr sw aly cta	RVU+GPCI+CF
76984	26	Dx intraop thoracic aorta us	RVU+GPCI+CF
76984	TC	Dx intraop thoracic aorta us	By Report
76984		Dx intraop thoracic aorta us	By Report
76987		Dx intraop epicar car us chd	By Report
76987	TC	Dx intraop epicar car us chd	By Report
76987	26	Dx intraop epicar car us chd	RVU+GPCI+CF
76988	TC	Dx ntrop epcr us chd img acq	By Report
76988	26	Dx ntrop epcr us chd img acq	RVU+GPCI+CF
76988		Dx ntrop epcr us chd img acq	By Report
76989		Dx intraop epcar us chd i&r	By Report
76989	26	Dx intraop epcar us chd i&r	RVU+GPCI+CF
76989	TC	Dx intraop epcar us chd i&r	By Report
81457		So neo gsap dna mcrstl ins	No payment amount
81458		So gsap dna cpy nmbr&mcrstl	No payment amount
81459		So neo gsap dna/dna&rna	No payment amount
81462		So gsap cll fr dna/dna&rna	No payment amount
81463		So gsap cl fr cpy nmbr&mcrst	No payment amount
81464		So gsap cll fr mcrstl ins	No payment amount
81517		Liver ds alys 3 bmrk srm alg	Section 9789.50 establishes payment conditions
82166		Assay anti-mullerian horm	Section 9789.50 establishes payment conditions
86041		Acetylcholn rcptr bndng antb	Section 9789.50 establishes payment conditions
86042		Acetylcholn rcptr blckg antb	Section 9789.50 establishes payment conditions
86043		Acetylcholn rcptr modlg antb	Section 9789.50 establishes payment conditions
86366		Muscle-specific kinase antb	Section 9789.50 establishes payment conditions
87523		Hepatitis d quantification	Section 9789.50 establishes payment conditions
90380		Rsv monoc antb seasn .5ml im	By Report
90381		Rsv monoc antb seasn 1 ml im	By Report
90480		Admn sarscov2 vacc 1 dose	By Report
90589		Chikungunya vaccine live im	By Report
90623		Menacwy-tt menb-fhbp vacc im	By Report
90679		Rsv vacc pref recomb adjt im	By Report
90683		Rsv vacc mrna lipid nano im	By Report
91318		Sarscov2 vac 3mcg trs-suc im	By Report
91319		Sarscv2 vac 10mcg trs-suc im	By Report
91320		Sarscv2 vac 30mcg trs-suc im	By Report
91321		Sarscov2 vac 25 mcg/.25ml im	By Report
91322		Sarscov2 vac 50 mcg/0.5ml im	By Report
92622		Dx aly aud oi snd prcsr 1st	RVU+GPCI+CF
92623		Dx aly aud oi snd prcsr each	RVU+GPCI+CF
92972		Perq trluml coronry lithotrp	RVU+GPCI+CF
93150		Therapy activation ipnss	RVU+GPCI+CF
93151		Interrog&prgrmg ipnss	RVU+GPCI+CF
93152		Interrog&prgrmg ipnss polysm	RVU+GPCI+CF
93153		Interrog w/o prgrmg ipnss	RVU+GPCI+CF
93297	TC	Rem interrog dev eval icpms	RVU+GPCI+CF
93297	26	Rem interrog dev eval icpms	RVU+GPCI+CF
93298	26	Rem interrog dev eval scrms	RVU+GPCI+CF
93298	TC	Rem interrog dev eval scrms	RVU+GPCI+CF
93584		Vngrph chd anom/persist svc	RVU+GPCI+CF
93585		Vngrph chd azygs/hemiazygs	RVU+GPCI+CF
93586		Vngrph chd coronary sinus	RVU+GPCI+CF
93587		Vngrph chd vnvn cltrl at/abv	RVU+GPCI+CF
93588		Vngrph chd vnvn cltrl below	RVU+GPCI+CF
96380		Admn rsv monoc antb im cnsl	RVU+GPCI+CF
96381		Admn rsv monoc antb im njx	RVU+GPCI+CF
96547		Intraop hipec px 1st 60 min	By Report
96548		Ntraop hipec px ea add 30min	By Report
97037		Appl modality 1+lllt po pain	By Report
97550		Caregiver traing 1st 30 min	RVU+GPCI+CF
97551		Caregiver traing ea addl 15	RVU+GPCI+CF
97552		Group caregiver training	RVU+GPCI+CF
99459		Pelvic examination	RVU+GPCI+CF
0743T	TC	B1 str & fx rsk vrt fx assmt	By Report
0743T	26	B1 str & fx rsk vrt fx assmt	By Report
0784T		Ins/rplmt eltrd ra spi nstim	By Report
0785T		Revj/rmvl nea spi w/nstim	By Report
0786T		Insj/rplcmt prq ra sac nstim	By Report
0787T		Revj/rmvl nea sac w/nstim	By Report
0788T		Elec aly smp iins sp/sac nrv	By Report
0789T		Elec aly cpx iins sp/sac nrv	By Report
0790T		Revj rplcmt/rmvl vrt tethrg	By Report
0811T		Rem mlt day uroflow setup	By Report
0812T		Rem mlt day uroflow dev sply	By Report
0813T		Egd vol adjmt bariatric balo	By Report
0814T		Prq njx biod osteo matrl fem	By Report
0815T		Us rems b1 dns hips plvs/spi	By Report
0815T	26	Us rems b1 dns hips plvs/spi	By Report
0815T	TC	Us rems b1 dns hips plvs/spi	By Report
0816T		Opn insj/rplcmt ins ptn subq	By Report
0817T		Opn insj/rplcmt ins ptn subf	By Report
0818T		Revj/rmvl ins ptn subq	By Report
0819T		Revj/rmvl ins ptn subf	By Report
0820T		Mntr psychdlc med 1stphy/qhp	By Report
0821T		Mntr psychdlc med 2ndphy/qhp	By Report
0822T		Mntr psychdlc med cln staff	By Report
0823T		Tcat ins 1chmbr ldls pm ra	By Report
0824T		Tcat rmv 1chmbr ldls pm ra	By Report
0825T		Tcat rmv&rpl1chmb ldls pm ra	By Report
0826T	TC	Prgrmg evl ldls pm 1chmbr ip	By Report
0826T		Prgrmg evl ldls pm 1chmbr ip	By Report
0826T	26	Prgrmg evl ldls pm 1chmbr ip	By Report
0827T		Dgtz gls mcrscp cytp smears	By Report
0828T		Dgtz gls mcrscp cytp smpl fl	By Report
0829T		Dgtz gls mcrscp cytp conctrj	By Report
0830T		Dgtz gls mcrscp cytp slctv	By Report
0831T		Dgtz gls mcrscp cytp c/v	By Report
0832T		Dgtz gls mcrscp cytp oth scr	By Report
0833T		Dgtz gls mcrscp cytp oth prp	By Report
0834T		Dgtz gls mcrscp cytp oth xtn	By Report
0835T		Dgtz gls mcrscp fna 1st ea	By Report
0836T		Dgtz gls mcrscp fna ea addl	By Report
0837T		Dgtz gls mcrscp fna i&r	By Report
0838T		Dgtz gls mcrscp cslt sld els	By Report
0839T		Dgtz gls mcrscp cslt mat prp	By Report
0840T		Dgtz gls mcrscp cslt compre	By Report
0841T		Dgtz gls mcrscp pth cslt 1st	By Report
0842T		Dgtz gls mcrscp pth cslt ea	By Report
0843T		Dgtz gls mcrscp cslt cyt 1st	By Report
0844T		Dgtz gls mcrscp cslt cyt ea	By Report
0845T		Dgtz gls mcrscp imfluor 1st	By Report
0846T		Dgtz gls mcrscp imfluor ea	By Report
0847T		Dgtz gls mcrscp xm arch tiss	By Report
0848T		Dgtz gls mcrscp ish 1st	By Report
0849T		Dgtz gls mcrscp ish ea adl 1	By Report
0850T		Dgtz gls mcrscp ish ea mult	By Report
0851T		Dgtz gls mcrscp mphmtrc 1st	By Report
0852T		Dgtz gls mcrscp mphmtrc ea 1	By Report
0853T		Dgtz gls mcrscp mphmtrc ea m	By Report
0854T		Dgtz gls mcrscp bld smr prph	By Report
0855T		Dgtz gls mcrscp b1 marow smr	By Report
0856T		Dgtz gls mcrscp electron mic	By Report
0857T	TC	Opto-acoustic img breast uni	By Report
0857T	26	Opto-acoustic img breast uni	By Report
0857T		Opto-acoustic img breast uni	By Report
0858T		Ext trnscranl mag stimj meas	By Report
0858T	26	Ext trnscranl mag stimj meas	By Report
0858T	TC	Ext trnscranl mag stimj meas	By Report
0859T		Ncntc ifr spctrsc o/t pad ea	By Report
0860T		Ncntc ifr spctrsc scr pad	By Report
0861T		Rmvl pg wcs lv both compnt	By Report
0862T		Rlcj pg wcs lv battery only	By Report
0863T		Rlcj pg wcs lv trnsmtr only	By Report
0864T		Low ntsty eswt corpus cvrnsm	By Report
0865T	TC	Quan mri alys brn w/o dx mri	By Report
0865T		Quan mri alys brn w/o dx mri	By Report
0865T	26	Quan mri alys brn w/o dx mri	By Report
0866T	26	Quan mri alys brn w/dx mri	By Report
0866T	TC	Quan mri alys brn w/dx mri	By Report
0866T		Quan mri alys brn w/dx mri	By Report
A4287		Disp col sto bag breast milk	By Report
A4457		Enema tube any type repl	By Report
A4468		Exsuff belt incl all sup acc	By Report
A4540		Trans elec nerv periph nerv	By Report
A4541		Monthly supp use with e0733	Section 9789.60 establishes payment conditions
A4542		Supp ext up limb tremor stim	Section 9789.60 establishes payment conditions
A6520		G com garmnt glove nghttime	Section 9789.60 establishes payment conditions
A6521		G com garmnt glove nght cust	Section 9789.60 establishes payment conditions
A6522		G com garment arm nighttime	Section 9789.60 establishes payment conditions
A6523		G com garment arm nght custm	Section 9789.60 establishes payment conditions
A6524		G com garmnt lwr leg/ft nght	Section 9789.60 establishes payment conditions
A6525		G com garm lwrleg/ft ngt cus	Section 9789.60 establishes payment conditions
A6526		G com garmt full leg/ft nght	Section 9789.60 establishes payment conditions
A6527		G garmt full leg/ft nght cus	Section 9789.60 establishes payment conditions
A6528		G com garment bra nighttime	Section 9789.60 establishes payment conditions
A6529		G com garmt bra night custm	Section 9789.60 establishes payment conditions
A6552		Grad com stocking bk 30-40	Section 9789.60 establishes payment conditions
A6553		G com stcking bk 30-40 custm	Section 9789.60 establishes payment conditions
A6554		Grad com stocking bk 40+	Section 9789.60 establishes payment conditions
A6555		G com stcking bk 40+ custm	Section 9789.60 establishes payment conditions
A6556		G com stcking thgh18-30 cust	Section 9789.60 establishes payment conditions
A6557		G com stcking thgh30-40 cust	Section 9789.60 establishes payment conditions
A6558		G com stcking thgh 40+ cust	Section 9789.60 establishes payment conditions
A6559		G stckng full/chap18-30 cust	By Report
A6560		G stckng full/chap30-40 cust	By Report
A6561		G stockng full/chap 40+ cust	By Report
A6562		G com stckng waist18-30 cust	Section 9789.60 establishes payment conditions
A6563		G com stckng waist30-40 cust	Section 9789.60 establishes payment conditions
A6564		G com stckng waist 40+ cust	Section 9789.60 establishes payment conditions
A6565		Grad comp gauntlet custom	Section 9789.60 establishes payment conditions
A6566		Grad com garment neck/head	Section 9789.60 establishes payment conditions
A6567		G com garment neck/head cust	Section 9789.60 establishes payment conditions
A6568		G com garment torso/shldr	Section 9789.60 establishes payment conditions
A6569		G com garmnt torso/shdr cust	Section 9789.60 establishes payment conditions
A6570		Grad com garment genital	Section 9789.60 establishes payment conditions
A6571		G com garment genital custm	Section 9789.60 establishes payment conditions
A6572		Grad com garment toe caps	Section 9789.60 establishes payment conditions
A6573		Grad com garmnt toe cap cust	Section 9789.60 establishes payment conditions
A6574		Custom gradient sleev/glov	Section 9789.60 establishes payment conditions
A6575		Gradient comp sleev/glov	Section 9789.60 establishes payment conditions
A6576		Custom grad com sleeve med	Section 9789.60 establishes payment conditions
A6577		Custom grad cm sleeve heavy	Section 9789.60 establishes payment conditions
A6578		Gradient comp sleeve	Section 9789.60 establishes payment conditions
A6579		Custom grad com glove med	Section 9789.60 establishes payment conditions
A6580		Custom grad com glove heavy	Section 9789.60 establishes payment conditions
A6581		Gradient comp glove	Section 9789.60 establishes payment conditions
A6582		Gradient comp gauntlet	Section 9789.60 establishes payment conditions
A6583		Grad com wrap w straps bk	Section 9789.60 establishes payment conditions
A6584		Grad com wrap w straps	By Report
A6585		Grad com wrap w straps ak	Section 9789.60 establishes payment conditions
A6586		Grad com wrap w straps leg	Section 9789.60 establishes payment conditions
A6587		Grad com wrap w straps foot	Section 9789.60 establishes payment conditions
A6588		Grad com wrap w straps arm	Section 9789.60 establishes payment conditions
A6589		Grad com wrap w straps bra	Section 9789.60 establishes payment conditions
A6593		Grad com accessory gmt_wrap	By Report
A6594		G comp bandge liner lwr extr	Section 9789.60 establishes payment conditions
A6595		G comp bandge liner upr extr	Section 9789.60 establishes payment conditions
A6596		G comp bandge conform gauze	Section 9789.60 establishes payment conditions
A6597		G comp bandage long stretch	Section 9789.60 establishes payment conditions
A6598		G comp bandage med stretch	Section 9789.60 establishes payment conditions
A6599		G comp bandage short stretch	Section 9789.60 establishes payment conditions
A6600		G com bandge hgh dn foam sht	Section 9789.60 establishes payment conditions
A6601		G com bandge hgh dn foam pad	Section 9789.60 establishes payment conditions
A6602		G com bandge hgh dn foamroll	Section 9789.60 establishes payment conditions
A6603		G com bandge low dn foamchnl	Section 9789.60 establishes payment conditions
A6604		G com bandge low dn foam flt	Section 9789.60 establishes payment conditions
A6605		G com bandage padded foam	Section 9789.60 establishes payment conditions
A6606		G com bandage padded textile	Section 9789.60 establishes payment conditions
A6607		G com bandage tub protct lyr	Section 9789.60 establishes payment conditions
A6608		G com bandage tub protct pad	Section 9789.60 establishes payment conditions
A6609		G compression bandaging	By Report
A6610		G com stcking bk 18-30 custm	Section 9789.60 establishes payment conditions
A7023		Mech allergen parti barrier	By Report
A9608		Flotufolastat f18 diag 1 mci	By Report
A9609		F18 fdg, 15 millicuries	By Report
D0396		3d print of 3d surface scan	By Report
D1301		Immunization counseling	By Report
D2976		Band stabilization per tooth	By Report
D2989		Excavate tooth non-restorabl	By Report
D2991		App of hydroxyapatite	By Report
D6089		Access/retorq implant screw	By Report
D7284		Exc biopsy of saliv glands	By Report
D7939		Indexing for osteotomy	By Report
D9938		Fab removable appliance	By Report
D9939		Placemnt removable appliance	By Report
D9954		Fab/del oral appliance thxpy	By Report
D9955		Oral app thxpy titration vis	By Report
D9956		Admin home sleep apnea test	By Report
D9957		Screening sleep disorders	By Report
G0011		Hiv prep counsel, md 15-30m	RVU+GPCI+CF
G0012		Injection of hiv prep drug	RVU+GPCI+CF
G0013		Hiv prep counsel, clin staff	RVU+GPCI+CF
G0017		Crisis psychotherapy 60m	RVU+GPCI+CF
G0018		Crisis psychotherapy add 30m	RVU+GPCI+CF
G0019		Comm hlth intg svs sdoh 60mn	RVU+GPCI+CF
G0022		Comm hlth intg svs add 30 m	RVU+GPCI+CF
G0023		Pin service 60m per month	RVU+GPCI+CF
G0024		Pin srv add 30 min pr m	RVU+GPCI+CF
G0136		Adm of soc dtr assess 5-15 m	RVU+GPCI+CF
G0137		Inten outpt svs,min 9 pr 7 d	By Report
G0140		Nav srv peer sup 60 min pr m	RVU+GPCI+CF
G0146		Nav srv peer sup add 30 pr m	RVU+GPCI+CF
G9886		In-person attendance g code	By Report
G9887		Distance learning attendance	By Report
G9888		5% wl maintnd from bsline wt	By Report
J0184		Inj, amisulpride, 1 mg	Section 9789.13.2 establishes payment conditions
J0217		Inj velmanase alfa-tycv 1 mg	Section 9789.13.2 establishes payment conditions
J0391		Inj, artesunate, 1mg	Section 9789.13.2 establishes payment conditions
J0402		Inj, abilify asimtufii, 1 mg	Section 9789.13.2 establishes payment conditions
J0576		Inj buprenorph (brixadi) 1mg	Section 9789.13.2 establishes payment conditions
J0688		Inj cefazolin sodium, hikma	Section 9789.13.2 establishes payment conditions
J0750		Hiv prep, ftc/tdf 200/300mg	By Report
J0751		Hiv prep, ftc/taf 200/25mg	By Report
J0799		Hiv prep, fda approved, noc	By Report
J0873		Inj, daptomycin (xellia)	By Report
J1105		Dexmedetomidine film, 1 mcg	By Report
J1246			By Report
J1304		Inj tofersen intrathec 1 mg	Section 9789.13.2 establishes payment conditions
J1412		Inj roctavian ml 2x10^13vc g	Section 9789.13.2 establishes payment conditions
J1413		Inj delandistrogene mox rokl	By Report
J1596		Inj, glycopyrrolate, 0.1 mg	Section 9789.13.2 establishes payment conditions
J1939		Inj, bumetanide, 0.5 mg	Section 9789.13.2 establishes payment conditions
J2404		Inj, nicardipine 0.1 mg	Section 9789.13.2 establishes payment conditions
J2508		Pegunigalsidase alfa-iwxj	Section 9789.13.2 establishes payment conditions
J2679		Inj fluphenazine hcl 1.25 mg	Section 9789.13.2 establishes payment conditions
J2799		Inj, uzedy, 1 mg	Section 9789.13.2 establishes payment conditions
J3401		Vyjuvek 5x10^9pfu/ml, 0.1 ml	Section 9789.13.2 establishes payment conditions
J3425		Inj, hydroxocobalamin	Section 9789.13.2 establishes payment conditions
J9052		Inj, carmustine (accord)	Section 9789.13.2 establishes payment conditions
J9072		Inj cyclophos dr.reddy's 5mg	Section 9789.13.2 establishes payment conditions
J9172		Docetaxel (ingenus), 1 mg	By Report
J9255		Inj, methotrexate (accord)	By Report
J9258		Paclitaxel (teva)	By Report
J9286		Inj glofitamab gxbm, 2.5 mg	Section 9789.13.2 establishes payment conditions
J9324		Inj, pemrydi rtu, 10 mg	By Report
J9333		Inj ronzanolixizum-noli 1 mg	Section 9789.13.2 establishes payment conditions
J9334		Inj efgart-alfa 2mg hya-qvfc	Section 9789.13.2 establishes payment conditions
M1211		Hemoglobin a1c level >9.0%	Reporting purposes only
M1212		Missing hb a1c level	Reporting purposes only
M1213		No hx spiro prs spiro>=70%	Reporting purposes only
M1214		Spiro results wth obs doc	Reporting purposes only
M1215		Med rsn for no doc spiro	Reporting purposes only
M1216		No spiro doc no res doc	Reporting purposes only
M1217		Sys rsn no doc spiro	Reporting purposes only
M1218		Pt copd symptoms	Reporting purposes only
M1219		Anphx due to vax	Reporting purposes only
M1220		Dre wth interp rtnopthy	Reporting purposes only
M1221		Dre w/o rtnopthy	Reporting purposes only
M1222		Glaucoma pln of care not doc	Reporting purposes only
M1223		Glaucoma plan of care doc	Reporting purposes only
M1224		Iop dec <20% from base	Reporting purposes only
M1225		Iop dec>=20% from base	Reporting purposes only
M1226		Iop not doc	Reporting purposes only
M1227		Eb therapy prescribed	Reporting purposes only
M1228		Pt + hcv aby +vir w/ rx 3 mo	Reporting purposes only
M1229		Pt w/ +hcv +vir ref win 1 mo	Reporting purposes only
M1230		Pt hcv rctv aby no f/u tst	Reporting purposes only
M1231		Pt hcv tst no reactive res	Reporting purposes only
M1232		Pt hcv tst reactive result	Reporting purposes only
M1233		Pt no hcv aby or result	Reporting purposes only
M1234		Pt hcv rctv aby f/u neg	Reporting purposes only
M1235		Doc pt hcv aby rna tst	Reporting purposes only
M1236		Baseline mrs > 2	Reporting purposes only
M1237		Pt rsn no scrn	Reporting purposes only
M1238		Doc 2nd recom hzv 2-6 mo int	Reporting purposes only
M1239		Pt no resp heard	Reporting purposes only
M1240		Pt no resp best int	Reporting purposes only
M1241		Pt no resp seen as person	Reporting purposes only
M1242		Pt no resp imprt to me	Reporting purposes only
M1243		Pt othr thn true heard	Reporting purposes only
M1244		Pt othr thn true best int	Reporting purposes only
M1245		Pt othr thn true person	Reporting purposes only
M1246		Pt othr thn true imprt to me	Reporting purposes only
M1247		Pt resp true best int	Reporting purposes only
M1248		Pt resp true seen as person	Reporting purposes only
M1249		Pt resp true imprt to me	Reporting purposes only
M1250		Pt resp true heard	Reporting purposes only
M1251		Pts proxy cmplt hu surv	Reporting purposes only
M1252		Pts no cmplt hu survey	Reporting purposes only
M1253		Pts hu surv no amb plltv	Reporting purposes only
M1254		Pts deceased prior hu surv	Reporting purposes only
M1255		Pts w/ othr rsn vst,+prg tst	Reporting purposes only
M1256		Prior history of known cvd	Reporting purposes only
M1257		Cvd risk assess not perf	Reporting purposes only
M1258		Cvd risk assess perf	Reporting purposes only
M1259		Pt kid transplt wtlst lv don	Reporting purposes only
M1260		Pt no kd trnsplt wtlst lv do	Reporting purposes only
M1261		Pts on wtlist bef dialysis	Reporting purposes only
M1262		Pts transplt bef dialysis	Reporting purposes only
M1263		Pts hosp dialysis dt	Reporting purposes only
M1264		Pts 75+ dialysis dt	Reporting purposes only
M1265		Cms 2728 completed	Reporting purposes only
M1266		Pts admit snf	Reporting purposes only
M1267		Pt no act kid transplt wtlst	Reporting purposes only
M1268		Pt ac stat kid trnsplt wtlst	Reporting purposes only
M1269		Rec'd esrd mcp lst day of mo	Reporting purposes only
M1270		Pts no kid transplt wtlst	Reporting purposes only
M1271		Pts dem any time/dur mo	Reporting purposes only
M1272		Pts kid transplt wtlst	Reporting purposes only
M1273		Pts snf 1 yr dialysis	Reporting purposes only
M1274		Pts snf exl mo	Reporting purposes only
M1275		Pts hosp exl	Reporting purposes only
M1276		Calc bmi out nrm param nof/u	Reporting purposes only
M1277		Colorectal ca screen doc rev	Reporting purposes only
M1278		Pre-htn or htn doc, f/u indc	Reporting purposes only
M1279		Pre-htn/htn, no f/u, not gvn	Reporting purposes only
M1280		Bilat mast/hx bi /unilat mas	Reporting purposes only
M1281		Bp scrn no perf at interval	Reporting purposes only
M1282		Pt scrn tbco id as non user	Reporting purposes only
M1283		Pt scrn tbco and id as user	Reporting purposes only
M1284		Pt 66+ snp or ltc pos > 90d	Reporting purposes only
M1285		Scrn mam perf rslts not doc	Reporting purposes only
M1286		Bmi doc onl fup not cmpltd	Reporting purposes only
M1287		Calc bmi blw low param f/u	Reporting purposes only
M1288		Doc rsn no hbp scrn or f/u	Reporting purposes only
M1289		No pt tbco cess interv rng	Reporting purposes only
M1290		Pt not eli d/t act dig htn	Reporting purposes only
M1291		Pt 66+ frailty and med dem	Reporting purposes only
M1292		Pt 66+ frail inpt adv ill	Reporting purposes only
M1293		Calc bmi abv up param f/u	Reporting purposes only
M1294		Bp scrn perf rec interval	Reporting purposes only
M1295		Pt hx tot col or colon ca	Reporting purposes only
M1296		Calc bmi norm parameters	Reporting purposes only
M1297		Bmi not doc medrsn ptref	Reporting purposes only
M1298		Doc pt preg dur msrmt pd	Reporting purposes only
M1299		Flu immunize order/admin	Reporting purposes only
M1300		Flu imm no admin doc rea	Reporting purposes only
M1301		Pt recv tbco cess interv	Reporting purposes only
M1302		Scrn mam perf rslts doc	Reporting purposes only
M1303		Hospc serv dur meas pd	Reporting purposes only
M1304		No pneum vax admin 19+	Reporting purposes only
M1305		Pneum vax admin 19+	Reporting purposes only
M1306		Pt anphx due to pneum	Reporting purposes only
M1307		Doc pt pal or hospice	Reporting purposes only
M1308		Flu immunize no admin	Reporting purposes only
M1309		Pall serv during meas	Reporting purposes only
M1310		Pt scr tob & cess int	Reporting purposes only
M1311		Aphlx to vax bef enc	Reporting purposes only
M1312		No pt tbco scrn rng	Reporting purposes only
M1313		No tob scr/cess int	Reporting purposes only
M1314		Bmi not calculated	Reporting purposes only
M1315		Crc no doc no rsn	Reporting purposes only
M1316		Tobacco non-user	Reporting purposes only
M1317		Pts counsl cpt opt out	Reporting purposes only
M1318		Pts no csp doc contact	Reporting purposes only
M1319		Pts csp doc contact	Reporting purposes only
M1320		Pts scrn + hrsn	Reporting purposes only
M1321		Pts no 7wk inj,no iop,iop>25	Reporting purposes only
M1322		Pts 7wk inj, scrn iop =<25	Reporting purposes only
M1323		Pts 7wk inj, scrn iop >25	Reporting purposes only
M1324		Pts intravitreal/pci	Reporting purposes only
M1325		Doc med rsn not seen	Reporting purposes only
M1326		Pts dx hypotony	Reporting purposes only
M1327		Pts no eval ini xm no 8 wks	Reporting purposes only
M1328		Pts dx acute vitreous hem	Reporting purposes only
M1329		Pts act pvd 2 wks 8 wks	Reporting purposes only
M1330		Doc pts rsn no f/u xm	Reporting purposes only
M1331		Pts eval ini xm 8 wks	Reporting purposes only
M1332		Pts no eval ini xm no 2 wks	Reporting purposes only
M1333		Acute vitreous hemorrhage	Reporting purposes only
M1334		Pts act pvd 2 wks 2 wks	Reporting purposes only
M1335		Doc pts rsn no f/u xm	Reporting purposes only
M1336		Pts eval ini xm 2 wks	Reporting purposes only
M1337		Acute pvd	Reporting purposes only
M1338		Pt f/u 30-180 dys no + imprv	Reporting purposes only
M1339		Pts f/u 30-180 dys + improv	Reporting purposes only
M1340		Indx whodas 2.0 or sds	Reporting purposes only
M1341		Pt no f/u 30-180 dys	Reporting purposes only
M1342		Pts died perf per	Reporting purposes only
M1343		Pt pam lvl 4 base or srt lin	Reporting purposes only
M1344		Pts no bsln or 2nd pam score	Reporting purposes only
M1345		Pt bsln pam, 2nd scr 6-12 mo	Reporting purposes only
M1346		Pts no pam 6 pts 6-12 mo	Reporting purposes only
M1347		Pt pam incr 3 pt 6-12 mo	Reporting purposes only
M1348		Pt pam incr 6 pt 6-12 mo	Reporting purposes only
M1349		Pt no pam 3 pts 6-12 mo	Reporting purposes only
M1350		Pt w/ suic saf pln init rev	Reporting purposes only
M1351		Pt cmplt suicd saf pln 120dy	Reporting purposes only
M1352		Suicd c-ssrs assessment, equ	Reporting purposes only
M1353		Pts no cmplt suicd saf pln	Reporting purposes only
M1354		Pt no suicd saf pln 120dy	Reporting purposes only
M1355		Suicd based cln eval	Reporting purposes only
M1356		Pt died dur meas pd	Reporting purposes only
M1357		Pt w/red suic idea 120 days	Reporting purposes only
M1358		Pts no <suicd idea 120 dys	Reporting purposes only
M1359		Indx suicd idea, no 0 scr	Reporting purposes only
M1360		Suicd c-ssrs assessment	Reporting purposes only
M1361		Suicd based cln eval	Reporting purposes only
M1362		Pt died dur meas pd	Reporting purposes only
M1363		Pts no f/u 120 dys	Reporting purposes only
M1364		Ascvd risk >=20pct	Reporting purposes only
M1365		Hosp+pall care spec code 17	Reporting purposes only
M1366		Focus on women's health mvp	Reporting purposes only
M1367		Qual care ent disorder mvp	Reporting purposes only
M1368		Prev trt inf d/o hiv/hep mvp	Reporting purposes only
M1369		Qualcare mental hlth/sud mvp	Reporting purposes only
M1370		Rehab support msk care mvp	Reporting purposes only
Q0516		Supply fee hiv prep 30-days	By Report
Q0517		Supply fee hiv prep 60-days	By Report
Q0518		Supply fee hiv prep 90-days	By Report
Q4279		Vendaje ac, per sq cm	By Report
Q4287		Dermabind dl, per sq cm	By Report
Q4288		Dermabind ch, per sq cm	By Report
Q4289		Revoshield+ amnio, per sq cm	By Report
Q4290		Membrane wrap hydr per sq cm	By Report
Q4291		Lamellas xt, per sq cm	By Report
Q4292		Lamellas, per sq cm	By Report
Q4293		Acesso dl, per sq cm	By Report
Q4294		Amnio quad-core, per sq cm	By Report
Q4295		Amnio tri-core, per sq cm	By Report
Q4296		Rebound matrix, per sq cm	By Report
Q4297		Emerge matrix, per sq cm	By Report
Q4298		Amnicore pro, per sq cm	By Report
Q4299		Amnicore pro+, per sq cm	By Report
Q4300		Acesso tl, per sq cm	By Report
Q4301		Activate matrix, per sq cm	By Report
Q4302		Complete aca, per sq cm	By Report
Q4303		Complete aa, per sq cm	By Report
Q4304		Grafix plus, per sq cm	By Report
Q5132		Inj, abrilada, 10 mg	By Report

154 Deleted HCPCS From Physician Services Fee Schedule

The update to the Physician Fee Schedule deletes 154 procedure codes. As listed below, these codes are no longer assigned any reimbursement by the DWC.

HCPCS	Modifier	Description
74710	TC	X-ray measurement of pelvis
74710	26	X-ray measurement of pelvis
74710		X-ray measurement of pelvis
91300		Sarscov2 vac 30mcg/0.3ml im
91301		Sarscov2 vac 100mcg/0.5ml im
91303		Sarscov2 vac ad26 .5ml im
91305		Sarscov2 vac 30 mcg trs-sucr
91306		Sarscov2 vac 50mcg/0.25ml im
91307		Sarscov2 vac 10 mcg trs-sucr
91308		Sarscov2 vac 3 mcg trs-sucr
91309		Sarscov2 vac 50mcg/0.5ml im
91311		Sarscov2 vac 25mcg/0.25ml im
91312		Sarscov2 vac bvl 30mcg/0.3ml
91313		Sarscov2 vac bvl 50mcg/0.5ml
91314		Sarscov2 vac bvl 25mcg/.25ml
91315		Sarscov2 vac bvl 10mcg/0.2ml
91316		Sarscov2 vac bvl 10mcg/0.2ml
91317		Sarscov2 vac bvl 3mcg/0.2ml
92065	TC	Orthop traing pfrmd phys/qhp
92065	26	Orthop traing pfrmd phys/qhp
0001A		Adm sarscov2 30mcg/0.3ml 1st
0002A		Adm sarscov2 30mcg/0.3ml 2nd
0003A		Adm sarscov2 30mcg/0.3ml 3rd
0004A		Adm sarscov2 30mcg/0.3ml bst
0011A		Adm sarscov2 100mcg/0.5ml1st
0012A		Adm sarscov2 100mcg/0.5ml2nd
0013A		Adm sarscov2 100mcg/0.5ml3rd
0031A		Adm sarscov2 vac ad26 .5ml
0034A		Adm sarscov2 vac ad26 .5ml b
0041A		Adm sarscov2 5mcg/0.5ml 1st
0042A		Adm sarscov2 5mcg/0.5ml 2nd
0044A		Adm sarscov2 5mcg/0.5ml bst
0051A		Adm sarscv2 30mcg trs-sucr 1
0052A		Adm sarscv2 30mcg trs-sucr 2
0053A		Adm sarscv2 30mcg trs-sucr 3
0054A		Adm sarscv2 30mcg trs-sucr b
0064A		Adm sarscov2 50mcg/0.25mlbst
0071A		Adm sarscv2 10mcg trs-sucr 1
0072A		Adm sarscv2 10mcg trs-sucr 2
0073A		Adm sarscv2 10mcg trs-sucr 3
0074A		Adm sarscv2 10mcg trs-sucr b
0081A		Adm sarscv2 3mcg trs-sucr 1
0082A		Adm sarscv2 3mcg trs-sucr 2
0083A		Adm sarscv2 3mcg trs-sucr 3
0091A		Adm sarscov2 50 mcg/.5 ml1st
0092A		Adm sarscov2 50 mcg/.5 ml2nd
0093A		Adm sarscov2 50 mcg/.5 ml3rd
0094A		Adm sarscov2 50 mcg/.5 mlbst
0111A		Adm sarscov2 25mcg/0.25ml1st
0112A		Adm sarscov2 25mcg/0.25ml2nd
0113A		Adm sarscov2 25mcg/0.25ml3rd
0121A		Adm sarscv2 bvl 30mcg/.3ml 1
0124A		Adm sarscv2 bvl 30mcg/.3ml a
0134A		Adm sarscv2 bvl 50mcg/.5ml a
0141A		Adm srscv2 bvl 25mcg/.25ml 1
0142A		Adm srscv2 bvl 25mcg/.25ml 2
0144A		Adm srscv2 bvl 25mcg/.25ml 2
0151A		Adm sarscv2 bvl 10mcg/.2ml 1
0154A		Adm sarscv2 bvl 10mcg/.2ml a
0164A		Adm srscv2 bvl 10mcg/0.2ml a
0171A		Adm sarscv2 bvl 3mcg/0.2ml 1
0172A		Adm sarscv2 bvl 3mcg/0.2ml 2
0173A		Adm sarscv2 bvl 3mcg/0.2ml 3
0174A		Adm sarscv2 bvl 3mcg/0.2ml a
0404T		Trnscrv uterin fibroid abltj
0424T		Insj/rplc nstim apnea compl
0425T		Insj/rplc nstim apnea sen ld
0426T		Insj/rplc nstim apnea stm ld
0427T		Insj/rplc nstim apnea pls gn
0428T		Rmvl nstim apnea pls gen
0429T		Rmvl nstim apnea sen ld
0430T		Rmvl nstim apnea stimj ld
0431T		Rmvl/rplc nstim apnea pls gn
0432T		Repos nstim apnea stimj ld
0433T		Repos nstim apnea sensing ld
0434T		Interro eval npgs apnea
0435T		Prgrmg eval npgs apnea 1 ses
0436T		Prgrmg eval npgs apnea study
0465T		Supchrdl njx rx w/o supply
0499T		Cysto f/urtl strix/stenosis
0501T		Cor ffr derived cor cta data
0502T		Cor ffr data prep & transmis
0503T		Cor ffr alys gnrj ffr mdl
0504T		Cor ffr data review i&r
0508T	TC	Pls echo us b1 dns meas tib
0508T	26	Pls echo us b1 dns meas tib
0508T		Pls echo us b1 dns meas tib
0533T	26	Cont rec mvmt do 6-10 days
0533T		Cont rec mvmt do 6-10 days
0533T	TC	Cont rec mvmt do 6-10 days
0534T		Cont rec mvmt do setup&train
0534T	TC	Cont rec mvmt do setup&train
0534T	26	Cont rec mvmt do setup&train
0535T	26	Cont rec mvmt do reprt cnfig
0535T	TC	Cont rec mvmt do reprt cnfig
0535T		Cont rec mvmt do reprt cnfig
0536T		Cont rec mvmt do dl w/i&r
0536T	26	Cont rec mvmt do dl w/i&r
0536T	TC	Cont rec mvmt do dl w/i&r
0641T		Ncntc nr ifr spctrsc wnd img
0642T		Ncntc nr ifr spctrsc wnd i&r
0715T		Perq trluml coronry lithotrp
0768T		Tc mag stimj pn sbsq tx 1nrv
0769T		Tc mag stimj pn sbsq tx ea
0775T		Arthrd si jt prq iartic impl
0809T		Arthrd si jt prq tfx&implt
G0056		Opt chronic dx mang mvp
G2023		Specimen collect covid-19
G2024		Spec coll snf/lab covid-19
G2066		Inter devc remote 30d
G2108		Pt 66+ snp or ltc pos > 90d
G2109		Pt 66+ frailty and med dem
G2110		Pt 66+ frailty and adv ill
G8506		Pt rec ace/arb
G8818		Pt disch to home by day#7
G8825		Pt not disch to home day#7
G8852		Pos air press prescribe
G8883		Rev, comm, track, doc biopsy
G8884		Doc reas biopsy not review
G8885		No rev, comm, track biopsy
G8941		Eld maltreatment doc as pos
G8963		Csi per asx pt w/pci 2 yrs
G8964		Csi any other than pci 2 yr
G9192		System reason for no beta
G9229		Ptrsn no gc chl syp test
G9451		1x scrn hcv infect
G9453		Pt reas no hcv infect
G9454		No scr hcv inf 12 mth rp
G9596		Ped pt hd ct ord
G9612		Phodoc 2 mr cec lndmk
G9613		Doc post surg anatomy
G9614		Photodoc < 2 cec lndmk
G9697		Pt rsn no presc bronchdil
G9715		Pt w/hosp anytime msmt per
G9725		Pt w/hosp anytime msmt per
G9852		Pt died from cancer
G9853		Icu stay last 30d life
G9854		No icu stay last 30d life
G9927		Doc no warf /fda pt trial
G9995		Pall serv during meas
J0610		Calcium glucon (fresenius)
J0611		Calcium glucon (wg critical)
J0800		Corticotropin injection
J2370		Phenylephrine hcl injection
J9160		Denileukin diftitox inj
M1156		Pt recd actv chemo any time
M1157		Pt recd bone mar trnsplt
M1158		Pt hx immcomp prior/dur pd
S0020		Injection, bupivicaine hydro
S0030		Injection, metronidazole
S0073		Injection, aztreonam, 500 mg
S0077		Injection, clindamycin phosp
S0166		Inj olanzapine 2.5mg
S0171		Bumetanide 0.5 mg

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