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CA OMFS: New Billing Codes for Physician Fee Schedule

September 27, 2018 by Catherine Montgomery

California’s Division of Workers’ Compensation (DWC) ordered updates to the Physician and Non-Physician Practitioner portion of Official Medical Fee Schedule (OMFS), effective October 1, 2018.

The order adopts several changes to the Medicare payment system, including quarterly updates to Relative Value Units (RVU) and National Correct Coding Initiative (NCCI) edits. In addition, the order includes the September 15 monthly Medi-Cal Rates file update for physician-administered drugs, biologicals, vaccines or blood products.

The order adds a total of 14 new billing codes for various Evaluation and Management (E/M) and injection services.

The Update Order

A September 18 DWC Newsline announced the order, which adjusts the Physician/Practitioner services portion to align with changes to Medicare, per California Labor Code Section 5307.1 mandates. The order adopts three Medicare changes:

  • The October 1, 2018 quarterly update to RVU File RVU18D
  • The October 1, 2018 quarterly update to NCCI Physician/Practitioner Services CCI Edits
  • The October 1, 2018 quarterly update to NCCI Medically Unlikely Edits (MUE)

Worth noting is the DWC’s exclusion of MUE codes with a value of “0” from the update order, following the epic kerfuffle over acupuncture and other billing codes this past summer.

New Billing Codes/Reimbursements

The update order does not alter reimbursement amounts for any existing codes. However, the order adds 14 new billing codes, 10 for E/M services and 4 for injections. Refer to the chart below for reimbursement information, noting that providers must bill for all four injection codes “By Report” (for detailed instructions on By Report billing, refer to this blog post).

Billing Code

Service

Reimbursement

G9978

Remote E/M new pt 10 min

$36.10

G9979

Remote E/M new pt 20 min

$68.13

G9980

Remote E/M new pt 30 min

$102.62

G9981

Remote E/M new pt 45 min

$173.72

G9982

Remote E/M new pt 60 min

$226.84

G9983

Remote E/M est. pt 10 min

$34.24

G9984

Remote E/M est. pt 15 min

$69.22

G9985

Remote E/M est. pt 25 min

$106.07

G9986

Remote E/M est. pt 40 min

$149.88

G9987

BPCI Advanced In home visit

$65.20

Q5105

Inj Retacrit esrd on dialysi

By Report

Q5106

Inj Retacrit non-esrd use

By Report

Q5108

Injection, fulphila

By Report

Q9994

Enzyme cartridge enteral nu

By Report

Stay tuned; pending further discussions with the DWC, we’ll report further on the exact nature of the E/M services now listed. And as always, we’ll keep you up to date on any other changes to the OMFS.


The OMFS is always changing. Fortunately, DaisyBill keeps up. Our OMFS Calculator, included with our Work Comp Wizard suite of billing tools, finds the correct reimbursement quickly and easily. Try it free today.

TRY THE OMFS CALCULATOR


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