CA OMFS: Pathology/Clinical Lab Fee Schedule Update Effective 10/1/2019

On October 4, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS), bringing the OMFS in line with Medicare’s 2019 fourth quarter changes to reimbursement.

This update is retroactive to dates of service rendered on or after October 1, 2019.

The update adds one new billing code, 0090U for gene expression profiling.

The DWC order, announced in a recent Newsline, incorporates by reference Medicare’s October 2019 quarterly update to the Medicare Clinical Laboratory Fee Schedule.

Specifically, the maximum reasonable fees for pathology and laboratory services shall not exceed 120% of the applicable fees contained in the electronic file “19CLABQ4,” found on the website for the Center for Medicare and Medicaid Services (CMS).  

Of note, the update to the Pathology and Clinical Laboratory Fee Schedule creates one new billing code:

New Billing Code

Procedure

OMFS Reimbursement

0090U

Onc cutan mlnma mrna 23 gene

$2,340.00


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