CA Fee Schedule Update: Physician Services (Q4 2026)

October 8, 2026 7 min read

By: the daisyNews Team

CA Fee Schedule Update: Physician Services (Q4 2026)

The California Division of Workers’ Compensation (CA DWC) issued a fourth-quarter update to the Physician and Non-Physician Practitioner Fee Schedule for workers’ compensation.

The changes are effective for all dates of service on or after October 1, 2026. The update adds reimbursement for 96 Healthcare Common Procedure Coding System (HCPCS) codes and changes the reimbursement calculations for 10 other HCPCS codes.

The update aligns the Physician Fee Schedule with changes to the Medicare payment system, as required by California Labor Code Section 5307.1. The CA DWC announced the update in a Newsline and posted the adoption order on its website.

daisyBIll clients do not need to take any action. Our billing software and Fee Schedule Calculator automatically incorporate the changes for all dates of service on or after October 1. We advise non-daisyBill providers to adjust their systems appropriately.

Read on for details!

Reimbursement Added for 96 HCPCS Codes

In the table below, each HCPCS code has a ‘Base Maximum Fee Reimbursement Calculation’ that indicates how to correctly calculate the reimbursement rate for the newly payable HCPCS codes.

For 6 HCPCS codes, the reimbursement is calculated using the following factors, expressed in the table as “RVU+GPCI+CF”:

The Medicare Relative Value Units (RVUs)
The Medicare Geographic Practice Cost Index (GPCI) for the location of service
The 2026 California Conversion Factor (CF)

For 88 HCPCS codes, reimbursement is determined “By Report.” The reimbursement rate for “By Report” codes is determined by identifying a comparable procedure in terms of the time, skill, and resources required and charging accordingly, per the instructions in California Code of Regulations (CCR) Section 9789.12.4.

For 2 HCPCS codes, the “Base Maximum Fee Reimbursement Calculation” refers to CCR § 9789.60, which is the section of California’s Official Medical Fee Schedule that establishes reimbursement conditions for those codes.

HCPCS	Modifier	Description	Base Maximum Fee Reimbursement Calculation
1054T		Fcsd nshckwv us prop resd st	By Report
1055T		Ntraop rf abltj lumpctmy cav	By Report
1056T		Cochlear infusion rx agent	By Report
1057T		Ins/rpl subq npg sprorb&ocpl	By Report
1058T		Revj subq sprorb&ocpl nstim	By Report
1059T		Rmvl subq sprorb&ocpl nstim	By Report
1060T		Elc aly sprorb-ocpl nstm cpx	By Report
1061T		Elc aly sprorb-ocpl nstm smp	By Report
1062T		Artif insem trnscrv ntratubl	By Report
1063T		Onc bldr aug alg aly rec&prg	By Report
1064T		Onc bldr augmnt alg alys bcg	By Report
1065T		Cysto co2 spray mnr bldr les	By Report
1066T		Cysto co2 spray sml bldr les	By Report
1067T		Cysto co2 spray med bldr les	By Report
1068T		Cysto co2 spray lrg bldr les	By Report
1069T		Mchnl xtr crycmprsn meas&edu	By Report
1070T		Mchnl xtr crycmprsn plmt	By Report
1071T		Mchnl xtr crycmprsn tx contn	By Report
1072T		Lvr algrft nrmthrmc mntr ea	By Report
1073T		Lvr algrft nrmthrmc dcannulj	By Report
1074T		Lvr algrft hypthrm cannulj	By Report
1075T		Lvr algrft hypthrm connj	By Report
1076T		Lvr algrft hypthrm mntr 1st	By Report
1077T		Lvr algrft hypthrm mntr ea	By Report
1078T		Lvr algrft hypthrm dcannulj	By Report
1079T		3d quan wtr bth us tomg brst	By Report
1079T	TC	3d quan wtr bth us tomg brst	By Report
1079T	26	3d quan wtr bth us tomg brst	By Report
1080T		Insj intracapsular magnifier	By Report
1081T		Mvasc anast lymph nod&vn 1st	By Report
1082T		Mvasc anast lymph node&vn ea	By Report
1083T		Strtctc plmt nfs cath brain	By Report
1084T		Impl scaf algrf sprchrdl spc	By Report
1085T		Asstv alg aly id les mets ca	By Report
1086T		Ntrapx est c ff aug alg alys	By Report
1087T		Est c ff drv aug alg alys	By Report
1088T		Perq appl hi-frq neuromd sgl	By Report
1089T		Io quan mcroelast tis charac	By Report
1090T		Atch&ins io lns prsth rx imp	By Report
1091T		Plmt perm com crtd art fltr	By Report
1092T		Imp aclr scaf kne chndr open	By Report
1093T		Imp aclr scaf kne chndr arth	By Report
1094T		Imp aclr scaf knee each addl	By Report
1095T		Hrv&pcx autol bmac mscskl tx	By Report
1096T		Njx thrmrg mltphas ssp dmyl8	By Report
1097T		Onc pncrs aug alg hmorph h&e	By Report
1098T		Plmt subrta prosth w/vtrc	By Report
1099T		Abltj ncmptnt vn ext tc hifu	By Report
1100T		Tc spi neuromd prgrmg ea 30	By Report
1101T		Tc spi neuromd appl each 15	By Report
1102T		Ntrop molec asmt lng tum tis	By Report
1103T		Ntrop molec asmt ov tub/prtl	By Report
1104T		N-invas cardpulm assmt cad	By Report
1105T		Prsnlz nstm pls rate aug alg	By Report
1106T		Onc brst aug alg hmorph h&e	By Report
1107T		Onc prst8 aug alg hmorph h&e	By Report
1108T		Strtctc icere impl 1+1traj	By Report
1109T		Strtctc icere impl 1+mlt trj	By Report
1110T		Strtctc icere dlvr 1 traj	By Report
1111T		Strtctc icere dlvr mlt traj	By Report
A2046		Dermisphere hdrt, per sq cm	RVU+GPCI+CF
A2047		Lacertamatrix, per sq cm	RVU+GPCI+CF
A2048		Puraply mz, per mg	By Report
A2049		Theracor, per sq cm	RVU+GPCI+CF
A2050		Fibrillar collagen, per mg	By Report
A4228		Dev-drug combo cath supplies	Section 9789.60 establishes payment conditions
A6614		Sup ext oculr neg pres pump	Section 9789.60 establishes payment conditions
A9613		F 18 pylarify truvu, dx 1mci	By Report
G0685		Algorithm assessment for asd	By Report
J0643		Inj leucovorin calcium 1 mg	By Report
J0644		Inj, leucovorin cal (avyxa)	By Report
J0871		Inj, daptomycin (endo) 1mg	By Report
J1757		Inj tivideno alfa-eknm 1	By Report
J1818		Inj pegzilarginase-nbln	By Report
J1946		Inj, furose lasixonyu, 1 mg	By Report
J1947		Inj, furoscix, 1 mg	By Report
J1957		Injection levetiracetam 5 mg	By Report
J1958		Inj levetirac sodi chlo 5 mg	By Report
J3268		Injection, delafloxacin	By Report
J3406		Inj omidubicel-onlv, tx dose	By Report
J7524		Mycophenol mofetil oral 5 mg	By Report
J7526		Inj mycophenola mofetil 5 mg	By Report
J7529		Mycop mofetil susp oral 5 mg	By Report
J7530		Mycophenolat (myhibbin) 5 mg	By Report
J7531		Pred sod pho ora dis ta 1 mg	By Report
J9066		Inj bendamustine, avyxa 1mg	By Report
J9186		Inj etoposide (avyxa), 1 mg	By Report
J9187		Inj, etoposide, 1 mg	By Report
J9191		Inj fluorouracil (avyxa)10mg	By Report
J9192		Inj, fluorouracil, 10 mg	By Report
J9362		Inj, trabectedin, 0.01 mg	By Report
Q4207		Carbon life, per sq cm	RVU+GPCI+CF
Q4223		Dermabind sl optic per sq cm	RVU+GPCI+CF
Q4243		Amchomatrix, per sq cm	RVU+GPCI+CF
Q5172		Inj, filkri, 1 mcg	By Report
Q5173		Inj, denosumab-adet, 1 mg	By Report

Reimbursement Calculation Changes for 10 Codes

For dates of service on or after October 1, the method for calculating reimbursement rates changes for 10 HCPCS billing codes. However, none of the changes are fee-affecting.

Reimbursement for HCPCS J7517 is determined “By Report.” As noted above, reimbursement rates for “By Report” codes are determined by identifying a comparable procedure in terms of the time, skill, and resources required and charging accordingly. Complete “By Report” billing instructions are available in California Code of Regulations Section 9789.12.4.
9 HCPCS codes have a new “Status Indicator” that is not fee-affecting. Medicare assigns all HCPCS codes a Status Indicator code (e.g., ‘E,’ ‘C’), which is used to determine reimbursement status. The Status Indicator changes for 9 HCPCS codes for dates of service on or after October 1. However, the status code changes will not impact the final reimbursement amounts.

Details of the reimbursement calculations for each of the 10 affected codes are shown in the table below. The table lists:

The HCPCS code affected by the CA DWC 2026 Physician and Non-Physician Fee Schedule update
The method for calculating reimbursement for dates of service prior to October 1, 2026
The method for calculating reimbursement, effective October 1, 2026
The Status Code for dates of service prior to October 1, 2026
The Status Code, effective October 1, 2026
Whether or not the change is “Fee-Affecting,” i.e., whether the reimbursement amount changes

HCPCS	Description	Reimbursement Calculation for Dates of Service Prior to October 1, 2026	New Reimbursement Calculation for Dates of Service On or After October 1, 2026	Status Code for Dates of Service Prior to October 1, 2026	Status Code or Dates of Service On or After October 1, 2026	Fee-Affecting Change?
J0640	Leucovorin calcium injection	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J1941	Inj, furoscix, 20 mg	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J1953	Levetiracetam injection	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J7514	Mycophenol (myhibbin) 100 mg	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J7517	Mycophenolate mofetil oral	By Report	By Report	E	I	No
J7519	Inj. mycophenolate mofetil	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J7528	Mycophen mofetil for susp	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J9181	Etoposide injection	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J9190	Fluorouracil injection	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No
J9352	Injection trabectedin 0.1mg	Section 9789.13.2. establishes payment conditions	Section 9789.12.3. establishes payment conditions	E	I	No

All bills providers submit via daisyBill will automatically reflect the most current, accurate reimbursement rates. If you have any questions regarding this update, use the chat function at the bottom right of this screen or email our experts at info@daisybill.com.

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