CA DWC: 2021 Fee Schedule Updates as of 1/5/2021

CA DWC: 2021 Fee Schedule Updates as of 1/5/2021

California workers’ comp fee schedules change on a regular basis, though not always on a precise schedule. This article sums up the late 2020 and early 2021 updates thus far posted or contemplated by the California Division of Workers’ Compensation (DWC), including updates to the fee schedules for DMEPOS, pathology and clinical laboratory, and in-patient hospital services.

We will publish future changes to the workers’ comp fee schedules as the DWC announces and adopts them.

Once the DWC posts the bulk of its updates, watch for the announcement of our annual (and hugely popular) webinar on changes to California’s Official Medical Fee Schedule (OMFS).

Medical-Legal fee schedule regulations

The DWC continues to hold hearings surrounding pending changes to the Medical-Legal Fee Schedule Regulations.

As of the date of this post, the DWC has not adopted changes to this fee schedule. Click the following link to download and review the currently proposed changes to the medical-legal fee schedule regulations: Text of regulation.

Physician services

As of the date of this post, the DWC has not adopted changes to this fee schedule; the 2020 reimbursements and billing rules remain unchanged.

Durable medical equipment, prosthetics, orthotics and supplies

Effective for services rendered on or after January 1, 2021, the maximum reasonable fees for durable medical equipment, prosthetics, orthotics and supplies shall not exceed 120% of the applicable California fees set forth in the Medicare calendar year 2021 “Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) Fee Schedule” revised effective January 2021, contained in the electronic file “DME21-A (ZIP)” but excluding:

  • the “Former CBA Fee Schedule File”,
  • “Former CBA National Mail-Order DTS Fee Schedule File”, and
  • “Former CBA Zip Code File”

Pathology and clinical laboratory

Except as set forth below, effective for services rendered on or after January 1, 2021, the maximum reasonable fees for pathology and clinical laboratory services shall not exceed 120% of the applicable fees set forth in the calendar year 2021 Medicare Clinical Laboratory Fee Schedule, contained in the electronic file “21CLABQ1” which is adopted and incorporated by reference.

COVID-19 Testing Codes and Specimen Collection Codes and Descriptors

Initial Effective Date

(Services on or After)

Maximum Workers’ Compensation Fee

(120% of Medicare Rate)

U0001

Short Descriptor: 2019 –nCoV diagnostic P

Long Descriptor: CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel

February 4, 2020

$43.09

U0002

Short Descriptor: COVID-19 lab test non-CDC

Long Descriptor: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

February 4, 2020

$61.57

CPT 87635

Short Descriptor: SARS-COV-2 COVID-19 AMP PRB

Long Descriptor: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

March 13, 2020

$61.57

(See CMS-Ruling 2020-1-R : “It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.”)

CPT 86769

Short Descriptor: SARS-COV-2 COVID-19 ANTIBODY

Long Descriptor: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

April 10, 2020

$50.56

CPT 86328

Short Descriptor: IA NFCT AB SARSCOV2 COVID19

Long Descriptor: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

April 10, 2020

$54.28

Inpatient hospital services

The effective date of the new rates is for inpatient hospital discharges occurring on or after December 1, 2020. The Administrative Director Order amending sections 9789.23, 9789.24, and 9789.25, and the explanation of changes is published in the inpatient hospital section of the DWC’s OMFS page.


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