Have trouble keeping up with California’s multiple fee schedule updates this year? It’s not just you.

As reported earlier this week, effective for all dates of service on or after April 1st, the Conversion Factor used to calculate the reimbursements for Physician and Non-Physician Practitioner Services increased.

With this most recent Conversion Factor increase, three different versions of the Physician Fee Schedule are already in effect for 2024 dates of service (DOS) — and it’s only April 3rd.

For 2024 DOS, these Conversion Factor changes have increased reimbursements by 2.75% for physician and non-physician services to injured workers. Understanding Conversion Factor details is critical to accurate charges and proper reimbursement analysis.

Below, we explain how a 2024 DOS determines the applicable Physician Fee Schedule reimbursement.

daisyBill providers can rest easy (and actually skip this article). daisyBill and its built-in Fee Schedule Calculator are always up to date and automatically provide accurate charges for every procedure billed for every DOS.

CA Physician 2024 Fee Schedule Changes

2024 is a particularly hectic year for anyone who calculates charges and analyzes reimbursements for physician services provided to injured workers.

The complexity arises from the three different Conversion Factors used to calculate the allowed reimbursement for 2024 DOS, shown in the table below.

From January 1 to April 1, the Conversion Factor has increased by a total of 2.75%. To illustrate how these multiple Conversion Factor increases affect reimbursements depending on the DOS, the table below lists reimbursements for a hypothetical bill that includes charges for:

• CPT 99214, a standard Evaluation and Management billing code with a Los Angeles County* place of service, and
• WC002, a California-specific billing code required for PR-2 Reports

*CPT 99214 is subject to location-based reimbursement calculations per Geographic Practice Cost Indices (GPCI), whereas CA-specific codes (like WC002) pay the same reimbursement amount statewide

Coupled with 2024 changes to Medicare RVU values, the Conversion Factor increases mean that total reimbursement for this bill would be 4.64% higher for a DOS in April than for a DOS in January.

Extrapolate that 4.64% increase across months’ worth of procedure codes and bills, and the difference to a practice’s bottom line is significant. For California practices that treat injured workers, adjusting your billing and revenue management to reflect all three 2024 Conversion Factors is a must.

If you’ve read this far (and you’re not a daisyBill provider), you may be shaking your head.

Without software that adapts to these ever-shifting fee schedules, implementing new charges and reimbursement analyses is a complex, tedious undertaking. To protect your practice, be sure to use the right billing technology.

Know (and get) exactly what you’re owed for treating injured workers. With daisyWizard's Fee Schedule Calculator, you can get instant, accurate fee schedule calculations.

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