CA OMFS: DMEPOS Fee Schedule Update Effective 7/1/2019

In Newsline No.: 2019-53, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthetics, and Orthotics (DMEPOS).

Effective for services rendered on or after July 1, 2019, the DWC adopted the Medicare July 2019 Quarter 3 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 July 2019, contained in the electronic file “DME19-C (updated 6/26/19),” excluding the “Former CBA Fee Schedule File,” “Former CBA National Mail-Order DTS Fee Schedule File,” and “Former CBA Zip Code File.”

Several reimbursement maximums were significantly reduced. Each of the procedure codes in the table below were reduced by about 10 percent with the largest reduction for K0553, which was reduced by just over 14 percent.

Procedure Code

Modifier

April

July

Change

E1353

¤

$43.61

$39.13

-10.27%

E1355

¤

$32.83

$29.48

-10.20%

K0553

¤

$308.27

$264.94

-14.06%

K0554

NU

$324.29

$292.08

-9.93%

K0554

RR

$32.44

$29.21

-9.96%

K0554

UE

$243.23

$219.06

-9.94%


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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