The California Division of Workers’ Compensation (CA DWC) issued an additional update to the Pathology and Clinical Laboratory portion of the Official Medical Fee Schedule (OMFS) for 2025.

This new update is effective for dates of service on or after January 1, 2025.

California Labor Code Section 5307.1 requires the CA DWC to align the OMFS with the Medicare payment system. The CA DWC announced its initial 2025 update to the Pathology and Clinical Laboratory fee schedule in December 2024 to conform to Medicare’s newest Clinical Laboratory Fee Schedule file.

However, on January 8, 2025, the Centers for Medicare and Medicaid Services (CMS) issued a subsequent, revised Clinical Laboratory Fee Schedule file—prompting the CA DWC to issue a new OMFS update order.

The CA DWC announced the additional update in a February 6 Newsline. The order is available to view on the CA DWC Pathology and Clinical Laboratory web page and includes:

• Ten new procedure codes
• An alteration to reimbursement rates for one existing procedure code

As always, daisyBillers may rest assured that our Revenue Cycle Management (RCM) software and daisyWizard’s OMFS Calculator are current and reflect the latest iteration of the fee schedule.

New Pathology and Clinical Laboratory Procedure Codes

Below, we list the 10 Healthcare Common Procedure Coding System (HCPCS) codes that the additional update adds to the Pathology and Clinical Laboratory fee schedule for California workers’ comp.

Pathology and Clinical Laboratory Procedure Code: Altered Reimbursement Rate

The additional update alters reimbursement for the HCPCS code below.

Again, all Pathology and Clinical Laboratory fee schedule changes, including the new rate for the code above, are reflected in daisyBill billing software and the daisyWizard OMFS Calculator.

And again, the changes listed here are effective for all dates of service on or after January 1. Per the CA DWC Newsline (emphases ours):

“The Administrative Director order dated December 27, 2024, remains in effect for services rendered on or after January 1, 2025, except as modified by the Administrative Director order dated February 6, 2025, which adopts the CMS Clinical Laboratory file updated January 8, 2025, in place of the original file.”

If you have any questions regarding fee schedules, contact us using the chat icon at the bottom right corner of this screen or email us at info@daisybill.com.

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