CA OMFS 2025: Pathology, Clinical Lab Fee Schedule Update

January 8, 2025 6 min read

By: the daisyNews Team

CA OMFS 2025: Pathology, Clinical Lab Fee Schedule Update

California’s Division of Workers’ Compensation (CA DWC) updated the Pathology and Clinical Laboratory portion of the Official Medical Fee Schedule (OMFS), effective for services rendered on or after January 1, 2025.

The CA DWC announced the order in a December 27th, 2024 Newsline. The update makes several significant changes to the Pathology/Clinical Laboratory fee schedule, including:

Adding 15 new Pathology codes
Deleting 6 Pathology codes
Changing reimbursement rates for 131 procedure codes

The update aligns the OMFS with the most recent changes to Medicare as required by California Labor Code Section 5307.1.

As always, daisyBill has updated daisyWizard’s OMFS Calculator and our Revenue Cycle Management (RCM) software with the latest reimbursements.

Pathology, Clinical Laboratory Fee Schedule Changes

The CA DWC update adopts the Center for Medicare and Medicaid (CMS)’s 2025 annual Pathology and Clinical Laboratory update. This includes fee schedule changes identified in the December 13, 2024 “CMS Transmittal 12992, Change Request CR 13889.”

The California workers’ comp Pathology/Clinical Laboratory fee schedule reimbursement rates remain at 120% of the Medicare reimbursement rates for the same services, specifically those set forth in the calendar year 2025 Quarter One Medicare Clinical Laboratory Fee Schedule, contained in the file “25CLABQ1.”

New Pathology and Clinical Laboratory Procedure Codes

Below we list the 15 Healthcare Common Procedure Coding System (HCPCS) codes the update adds to the Pathology and Clinical Laboratory fee schedule for California workers’ comp.

2025 New Path/Clinical Lab HCPCS	Modifier	HCPCS Description
81195		Cytog genom-wid alys hem mal
81515		Nfct ds bv&vaginitis dna alg
81515	QW	Nfct ds bv&vaginitis dna alg
81558		Trnspl rej kdn mrna qpcr 139
82233		Beta-amyloid 1-40 (abeta 40)
82234		Beta-amyloid 1-42 (abeta 42)
83884		Assay neurflmnt light chain
84393		Tau phosphorylated ea
84394		Total tau
86581		Strptcs pneum antb serot ia
87513		H pylri clrthmcn rst amp prb
87521	QW	Hepatitis c probe&rvrs trnsc
87564		Mtb rifampin rst amp prb tq
87594		Pneumcysts jirovecii amp prb
87626		Hpv sep hi-rsk typ&pool rslt

Deleted Pathology and Clinical Laboratory Procedure Codes

The update also deletes six HCPCS codes, as shown below.

2025 Deleted Path/Clinical Lab Procedure Code	HCPCS Description
0346U	Beta amyl ab40&ab42 lc-ms/ms
0352U	Nfct ds bv&vaginitis amp prb
0380U	Rx metb advrs trgt sq aly 20
0428U	Onc brst ctdna alys 56/> gen
0448U	Onc lng&cln ca dna qual ngs
0456U	Ai ra ngs 19 genes anti-ccp

Pathology and Clinical Laboratory Procedure Codes With Altered Reimbursement Rates

The update alters reimbursement amounts for the 131 HCPS codes listed below.

2025 Path/Clinical Lab Procedure Code With Reimbursement Change	HCPCS Description
36415	Coll venous bld venipuncture
80081	Obstetric panel inc hiv tstg
81432	Hrdtry brst ca-rlatd do 5+
81434	Hered rta do gen seq 15
81435	Hered colon ca-rlatd do 5+
81437	Hered neuroend tum-rlt do 5+
81457	So neo gsap dna mcrstl ins
81458	So gsap dna cpy nmbr&mcrstl
81459	So neo gsap dna/dna&rna
81462	So gsap cll fr dna/dna&rna
81463	So gsap cl fr cpy nmbr&mcrst
81464	So gsap cll fr mcrstl ins
81554	Pulm ds ipf mrna 190 gen alg
82009	Ketone bodys qual
82010	Ketone bodys quan
82010	Ketone bodys quan
87164	Dark field exam spec collj
87166	Dark field exam w/o collj
87467	Hepatitis b surface ag quan
87468	Anaplsma phgcytophlm amp prb
87469	Babesia microti amp prb
87471	Bartonella dna amp probe
87472	Bartonella dna quant
87593	Orthopoxvirus amp prb each
87624	Hpv hi-risk typ pooled rslt
88148	Cytopath c/v auto rescreen
88150	Cytopath c/v manual
88164	Cytopath tbs c/v manual
88166	Cytopath tbs c/v auto redo
88167	Cytopath tbs c/v select
0019M	Cv ds plasma alys prtn bmrk
0095U	Ee 2 prtn bmrk elisa est
0334U	Onc sld orgn tgsa dna 84/+
0340U	Onc pan ca alys mrd plasma
0360U	Onc lung elisa 7 autoant alg
0361U	Neurflmnt lt chn dig ia quan
0364U	Onc hl neo gen seq alys alg
0365U	Onc bldr 10 ur hrbr urthl ca
0368U	Onc clrct ca mut&mthyltn mrk
0379U	Tgsap sl or neo dna523&rna55
0381U	Maple syrup ur ds mntr quan
0382U	Hyprphenylalninmia mntr quan
0383U	Tyrosinemia typ i mntr quan
0388U	Onc nonsm cll lng ca 37 gen
0389U	Ped fbrl kd ifi27&mcemp1 rna
0395U	Onc lng multiomics plsm alg
0398U	Gi baret esph dna mthyln aly
0399U	Neuro cere folate defncy srm
0400U	Ob xpnd car scr 145 genes
0401U	Crd c hrt ds 9 gen 12 vrnts
0408U	Iaad blk ac wv bsnsr sarscv2
0412U	Beta amyloid ab42/40 imprcip
0417U	Rare ds alys 335 nuc genes
0421U	Onc clrct scr sgl amp 8 rna
0423U	Psyc genomic alys pnl 26 gen
0424U	Onc prst8 xom alys 53 sncrna
0427U	Monocyte dstrbj wdth whl bld
0429U	Hpv orop swab 14 hi-risk typ
0430U	Gi malabs aat calpro pncrtc
0431U	Gly rcptr alpha1 igg srm/csf
0432U	Klhl11 antb sr/csf asy qual
0433U	Onc prst8 5 dna reg mrk pcr
0434U	Rx metab advrs vrnt alys 25
0435U	Onc chemo rx cytox csc 14 rx
0437U	Psyc anxiety do mrna 15 bmrk
0438U	Rx metab advrs vrnt alys 33
0442U	Nfct ds respir nfctj mxa&crp
0444U	Onc sld orgn neo tgsap 361
0445U	Abeta42 & ptau181 eclia csf
0446U	Ai ds sle alys 10 cytokine
0447U	Ai ds sle alys 11 cytokine
0449U	Car scr sev inh cond 5 genes
0450U	Onc mm lc-ms/ms monoc p-prtn
0451U	Onc mm lc-ms/ms pep ion quan
0452U	Onc bldr mthyl penk lte-qmsp
0453U	Onc clrct ca cfdna qpcr asy
0454U	Rare ds id opt genome mapg
0455U	Nfct agt sti mult amp prb ur
0457U	Pfas 9 cmpnd lcms/ms pls/sr
0458U	Onc brst ca s100 a8&a9 elisa
0459U	Abeta42 & ttau eclia csf
0462U	Melatonin lvl tst slp std7/9
0464U	Onc clrct scr qrtsa dna mrk
0465U	Onc urthl carc dna qmsp 2gen
0467U	Onc bldr dna ngs 60gen&aneup
0468U	Hep nash mir34a5p a2m ykl40
0469U	Rare ds whl gen seq ftl samp
0471U	Onc clrc ca 35 vrn kras&nras
0474U	Hered pan ca gsap 88gene ngs
0475U	Hered prst8 ca gsap 23 genes
0476U	Rx metab psyc 14gen&cyp2d6
0477U	Rx metab psy 14&cyp2d6 gn-rx
0479U	Tau phosphorylated ptau217
0480U	Nfct ds csf metag ngs alys
0481U	Idh1 idh2&tert promoter ngs
0482U	Ob pe biochem asy sflt1&plgf
0487U	Onc sol tum cfcdna tgsap 84
0488U	Ob fetal ag nipt cfdna alys
0490U	Onc cutan/uveal mlnma cd146
0491U	Onc sol tum ctc slct er prtn
0492U	Onc sol tum ctc slctn pd-l1
0493U	Trnspl med quan dd-cfdna ngs
0494U	Rbc ag ftl rhd gene alys ngs
0495U	Onc prst8 alys crcg plsm prt
0497U	Onc prst8 mrna rt-pcr 6genes
0499U	Onc clrct&lng dna ngs 8genes
0500U	Autoinflam ds vexas synd dna
0502U	Hpv e6/e7 mrk hi-rsk typ crv
0503U	Neuro alz ds bamyl&tau prtn
0504U	Nfct ds uti id 17 path orgs
0505U	Nfct ds vag infctj id 32orgs
0506U	Gi barretts esophgl cell 89
0507U	Onc ovr dna whole gen w/5hmc
0508U	Trnsplj med dd-cfdna 40 snps
0509U	Trnsplj med dd-cfdna<12 snps
0511U	Onc sol tum 3dmicroenvir 36+
0512U	Onc prst8 alys dgtz img msi
0513U	Onc prst8 alg alys msi&hrd
0514U	Gi ibd ia quan deter adl lvl
0515U	Gi ibd ia quan deter ifx lvl
0516U	Rx metab rxgenomic gnotyp 40
0517U	Ther rx mntr 80+ psyactiv rx
0518U	Ther rx mntr 90+ pn&mtl hlth
0519U	Ther rx mntr meds p/d/a 110+
0520U	Ther rx mntr 200+ rx/sbsts
G0147	Scr c/v cyto, automated sys
G0471	Ven blood coll snf/hha
P3000	Screen pap by tech w md supv
P9612	Catheterize for urine spec
P9615	Urine specimen collect mult
Q0111	Wet mounts/ w preparations

daisyBillers, rest easy. All Pathology and Clinical Laboratory fee schedule changes, including the new rates for the 131 codes above, are reflected in daisyBill billing software and the daisyWizard OMFS Calculator.

Again, the changes listed here are effective for all dates of service on or after January 1st.

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

Know exactly what you’re owed for treating injured workers. Get instant, accurate fee schedule calculations with daisyWizard’s OMFS Calculator.

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