CA OMFS: DMEPOS Fee Schedule Update Effective 10/1/2019

In Newsline No.: 2019-75, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthetics, and Orthotics (DMEPOS).

In addition to setting the maximum reimbursement at 120% of the equivalent Medicare DMEPOS reimbursement, this update adds a new reimbursable Procedure Code.

Effective for services rendered on or after October 1, 2019, the DWC adopted the Medicare October 2019 Quarter 4 DMEPOS Fee Schedule update.

Specifically, the maximum reasonable fees for DMEPOS shall not exceed 120% of the applicable California fees set forth in the Medicare DMEPOS Fee Schedule, revised effective October 2019, contained in the electronic file “DME19-D,” but excluding the “Former CBA Fee Schedule File,” “Former CBA National Mail-Order DTS Fee Schedule File,” and “Former CBA Zip Code File.”

Note that Procedure Code E0766 was added to the DMEPOS Fee Schedule in this most recent update.

New Billing Code

Modifier

OMFS Reimbursement

E0766

RR

$15,884.79


DaisyBill’s OMFS Calculator, the foundational tool of our Work Comp Wizard, automatically calculates reimbursements using the most recent Medicare files and DWC reimbursement formulas. The updated DMEPOS fee schedule is already loaded and active in our software.
Work Comp Wizard subscriptions come with a free three-day trial and are cancellable at any time. You can learn more on our website.

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