5 Things You Need to Know About the March OMFS Changes

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5 Things You Need to Know About the March OMFS Changes

Tomorrow’s the day. The new Physician and Non-Physician Fee Schedule – announced by the California Division of Workers’ Compensation in January – finally rolls into effect for 2017 dates of service on March 1. Here’s what you need to know.

1. Two Conversion Factors

More than four years later, Senate Bill 863 is still making its presence known. SB 863 requires that the conversion factor (CF) system is simplified in 2017.

In the past, there have been four separate CFs to keep track of – one for anesthesia, one for surgery, one for radiology, and one for all other services. Effective March 1, the conversion factors for surgery and radiology will roll into the CF for all other services, leaving a total of just two conversion factors – one for anesthesia, and one for all other services.

The new conversion factor for anesthesia stands at $26.8011, a decrease of almost seven percent over last year. All other services have a conversion factor of $44.6572, an increase of about five percent.[1] More information is available here.

2. New RVU File

Calculating reimbursement amounts for workers’ comp is notoriously tricky business. Each reimbursement requires the use of one of two formulas. In turn, each formula relies on three Relative Value Units, or RVUs. For dates of service on or after March 1, 2017, the DWC uses Medicare’s 2017 Quarter 1 RVUs, also known as the RVU17A. You can download the new RVU file from the Medicare website by clicking this link. For more information, head to our February 7 post.

3. CPT Codes 99358 and 99359 for Non-Face-To-Face Services

Major adjustments to the Official Medical Fee Schedule often include new CPT codes; today’s is no exception. Two of these codes in particular – 99358 and 99359 – allow physicians or nonphysician practitioners to bill for prolonged services that are not face-to-face.

  • 99358 – Prolonged evaluation and management service before and/or after direct patient care; first hour
  • 99359 (add-on code) – Each additional 30 minutes (List separately in addition to code 99358 for prolonged service)

As with all other CPT codes with a strictly-defined time component, the provider must meet over half of the specified time before billing. In this case, that means that a provider must spend 31 minutes or more before billing code 99358, and 76 minutes or more before adding code 99359.

For more information about these codes, head to our blog post or register for our upcoming webinar.

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4. Telehealth

Telehealth, the emerging collection of healthcare services available through telecommunication, is a rapidly-growing field. Its growth caught the eye of  the Centers for Medicare and Medicaid Services (CMS), prompting them to add the new place of service code 02 to the physician fee schedule for telemedicine, along with a host of newly-reimbursable telehealth CPT codes.

Telemedicine presents an intriguing possible source of revenue for California workers’ comp providers. To start with, any practice offering telemedicine services places itself at a competitive advantage – as the boundary between healthcare and technology continues to blur, it pays to keep up with the times. More information is available on our blog.

5. California-Specific Codes

Prior to 2014, a suite of California-specific codes were created by the DWC to cover services for which there are no appropriate CPT codes or HCPCS, such as the State of California Primary Physician Progress Report (DWC form PR-2). While the reimbursement rates for these codes are not directly affected by changes to the conversion factor or RVU file, CCR § 9789.12.14 specifies that they must nonetheless be updated annually “in accordance with the Medicare Economic Index.”

2017 is no exception. Most reimbursements climbed by about 1%. For a detailed analysis, visit our blog.

The DaisyBill OMFS Calculator – one of the six products offered through our Work Comp Wizard – is updated every time the DWC adjusts the workers’ comp fee schedule. That means that our clients never have to worry about out-of-date reimbursements. Should you ever need to access old reimbursements, simply enter a date of service prior to the date of the last OMFS changes.

If you’re curious about our Calculator, sign up below for a three-day trial to the Work Comp Wizard. You’ll be able to start calculating 2017 work comp reimbursements instantly, and you’ll gain access to a suite of other workers’ comp billing tools.


[1] While the conversion factor for “All Other Services” in 2017 is 5% higher than the same figure last year, it’s important to point out that this year’s number – $44.6572 – is actually lower than the individual 2016 conversion factors for surgery and radiology.

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