2023 CA Physician Fee Schedule Changes
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California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation, effective for all dates of service on or after February 15, 2023.
The update:
- Increases California workers’ comp’s Conversion Factor
- Alters the reimbursement calculation for 4 procedure codes
- Changes the Status Code of CPT 99358 and CPT 99359 to ‘I’
- Adds 409 new procedure codes
- Deletes 125 existing procedure codes
The update aligns the OMFS to relevant 2023 changes in the Medicare payment system, as required by California Labor Code Section 5307.1 (though as we explained previously, recent cuts to Medicare rates did not translate to lower overall reimbursement rates for physician services in California).
The DWC announced the update in a Newsline, and posted the order adopting the update on its website. Read on for details!
Conversion Factor Increased
Calculating reimbursement rates for physician services first requires determining the “Base Maximum Fee,” before applying other fee-affecting modifiers or rules. Under the current fee schedule, based on the Centers for Medicare and Medicaid Services’ (CMS) Resource-Based Relative Value Scale (RBRVS), the Base Maximum Fee is calculated using three factors:
- Relative Value Units (RVUs) as determined by Medicare
- Geographic Practice Cost Index (GPCI) as determined by Medicare
- Conversion Factor (CF) as determined by the California DWC
The Conversion Factor used to calculate OMFS reimbursements for physician services is increasing from $46.45 to $47.21 (even as Medicare rates decrease); the OMFS will pay 139.32% of Medicare rates for the same services.
With this Conversion Factor increase, the DWC is acknowledging that treating injured workers requires about 40% more work than treating a Medicare patient — though California still allows PPOs to drastically reduce reimbursement rates to well below OMFS (and sometimes even below Medicare) rates.
Reimbursement Calculation Altered
In addition to the above changes, 4 existing procedure codes formerly billable only “By Report” now have established reimbursement amounts:
HCPCS |
Description |
Reimbursement |
93247 |
Ext ecg>7d<15d scan a/r |
RVU+GPCI+CF |
93245 |
Ext ecg>7d<15d rec scan a/r |
RVU+GPCI+CF |
93243 |
Ext ecg>48hr<7d scan a/r |
RVU+GPCI+CF |
93241 |
Ext ecg>48hr<7d rec scan a/r |
RVU+GPCI+CF |
Effective February 15th, Medicare assigned the above-noted codes RVUs. Therefore, the reimbursements are now calculated using the appropriate GPCI assigned to the place of service, and the Conversion Factor adopted by the DWC.
CPTs 99358 and 99359 Non-Face-To-Face Services
Effective February 15, 2023, an update to the Official Medical Fee Schedule (OMFS) changes the Status Code of two commonly billed non-face-to-face service CPT codes, CPT 99358 and CPT 99359.
Despite the assigned status codes change, both procedure codes remain payable under the OMFS. See the video below for details.
Make calculating 2023 OMFS reimbursements easy: Try our OMFS Calculator for accurate, instant, always-updated rates (Fee Schedules: California, New York and US DOL).
HCPCS: 409 New Codes & 125 Deleted Codes
Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for 2023, as well as codes the DWC deleted.
Note that when Medicare fails to assign an HCPCS code a Relative Value Unit (RVU), the reimbursement is calculated “By Report” (BR).
California Code of Regulations Section 9789.12.4 offers guidelines to determine appropriate reimbursement amounts for BR codes; essentially, providers find a comparable procedure in terms of time, skill, and resources required, and charge accordingly. The provider must justify the amount charged with a separate (non-reimbursable) report.
2023 New HCPCS Codes for CA Workers’ Comp Physician Services
HCPCS |
Modifier |
Description |
Reimbursement |
15778 |
Impl absrb msh/prsth dly cls |
RVU+GPCI+CF |
|
15853 |
Removal sutr/stapl xreq anes |
RVU+GPCI+CF |
|
15854 |
Removal sutr&stapl xreq anes |
RVU+GPCI+CF |
|
22860 |
Tot disc arthrp 2ntrspc lmbr |
By Report |
|
30469 |
Rpr nsl vlv collapse w/rmdlg |
RVU+GPCI+CF |
|
33900 |
Perq p-art revsc 1 nm nt uni |
RVU+GPCI+CF |
|
33901 |
Perq p-art revsc 1 nm nt bi |
RVU+GPCI+CF |
|
33902 |
Perq p-art revsc 1 abnor uni |
RVU+GPCI+CF |
|
33903 |
Perq p-art revsc 1 abnor bi |
RVU+GPCI+CF |
|
33904 |
Perq p-art revsc each addl |
RVU+GPCI+CF |
|
36836 |
Prq av fstl crtj uxtr 1 acs |
RVU+GPCI+CF |
|
36837 |
Prq av fstl crt uxtr sep acs |
RVU+GPCI+CF |
|
43290 |
Egd flx trnsorl dplmnt balo |
RVU+GPCI+CF |
|
43291 |
Egd flx trnsorl rmvl balo |
RVU+GPCI+CF |
|
49591 |
Rpr aa hrn 1st < 3 cm rdc |
RVU+GPCI+CF |
|
49592 |
Rpr aa hrn 1st < 3 ncr/strn |
RVU+GPCI+CF |
|
49593 |
Rpr aa hrn 1st 3-10 rdc |
RVU+GPCI+CF |
|
49594 |
Rpr aa hrn 1st 3-10 ncr/strn |
RVU+GPCI+CF |
|
49595 |
Rpr aa hrn 1st > 10 rdc |
RVU+GPCI+CF |
|
49596 |
Rpr aa hrn 1st > 10 ncr/strn |
RVU+GPCI+CF |
|
49613 |
Rpr aa hrn rcr < 3 rdc |
RVU+GPCI+CF |
|
49614 |
Rpr aa hrn rcr < 3 ncr/strn |
RVU+GPCI+CF |
|
49615 |
Rpr aa hrn rcr 3-10 rdc |
RVU+GPCI+CF |
|
49616 |
Rpr aa hrn rcr 3-10 ncr/strn |
RVU+GPCI+CF |
|
49617 |
Rpr aa hrn rcr > 10 rdc |
RVU+GPCI+CF |
|
49618 |
Rpr aa hrn rcr > 10 ncr/strn |
RVU+GPCI+CF |
|
49621 |
Rpr parastomal hernia rdc |
RVU+GPCI+CF |
|
49622 |
Rpr parastomal hrna ncr/strn |
RVU+GPCI+CF |
|
49623 |
Rmvl ninfct mesh hernia rpr |
RVU+GPCI+CF |
|
55867 |
Laps surg prst8ect smpl stot |
RVU+GPCI+CF |
|
69728 |
Rmv ntr oi imp sktc esp>=100 |
RVU+GPCI+CF |
|
69729 |
Impl oi implt sk tc esp>=100 |
RVU+GPCI+CF |
|
69730 |
Rplc oi implt sk tc esp>=100 |
RVU+GPCI+CF |
|
76883 |
26 |
Us nrv&acc strux 1xtr compre |
RVU+GPCI+CF |
76883 |
Us nrv&acc strux 1xtr compre |
RVU+GPCI+CF |
|
76883 |
TC |
Us nrv&acc strux 1xtr compre |
RVU+GPCI+CF |
81418 |
Rx metab gen seq alys pnl 6 |
No payment amount |
|
81441 |
Ibmfs seq alys pnl 30 genes |
RVU+GPCI+CF |
|
81449 |
Tgsap so neo 5-50 rna alys |
RVU+GPCI+CF |
|
81451 |
Tgsap hl neo 5-50 rna alys |
RVU+GPCI+CF |
|
81456 |
Tgsap so/hl 51/> rna alys |
RVU+GPCI+CF |
|
84433 |
Asy thiopurin s-mthyltrnsfrs |
RVU+GPCI+CF |
|
87467 |
Hepatitis b surface ag quan |
RVU+GPCI+CF |
|
87468 |
Anaplsma phgcytophlm amp prb |
RVU+GPCI+CF |
|
87469 |
Babesia microti amp prb |
RVU+GPCI+CF |
|
87478 |
Borrelia miyamotoi amp prb |
RVU+GPCI+CF |
|
87484 |
Ehrlicha chaffeensis amp prb |
RVU+GPCI+CF |
|
87593 |
Orthopoxvirus amp prb each |
No payment amount |
|
90611 |
Smallpox&monkeypox vac 0.5ml |
By Report |
|
90622 |
Vaccinia vrs vac 0.3 ml perq |
By Report |
|
90678 |
Rsv vacc pref bivalent im |
By Report |
|
91305 |
Sarscov2 vac 30 mcg trs-sucr |
By Report |
|
91306 |
Sarscov2 vac 50mcg/0.25ml im |
By Report |
|
91312 |
Sarscov2 vac bvl 30mcg/0.3ml |
By Report |
|
91313 |
Sarscov2 vac bvl 50mcg/0.5ml |
By Report |
|
91314 |
Sarscov2 vac bvl 25mcg/.25ml |
By Report |
|
91315 |
Sarscov2 vac bvl 10mcg/0.2ml |
By Report |
|
92066 |
Orthop traing supvj phys/qhp |
RVU+GPCI+CF |
|
93569 |
Njx cth slct p-art angrp uni |
RVU+GPCI+CF |
|
93573 |
Njx cath slct p-art angrp bi |
RVU+GPCI+CF |
|
93574 |
Njx cath slct pulm vn angrph |
RVU+GPCI+CF |
|
93575 |
Njx cath slct p angrph mapca |
RVU+GPCI+CF |
|
95919 |
TC |
Quan puplmtry phy/qhp uni/bi |
RVU+GPCI+CF |
95919 |
26 |
Quan puplmtry phy/qhp uni/bi |
RVU+GPCI+CF |
95919 |
Quan puplmtry phy/qhp uni/bi |
RVU+GPCI+CF |
|
96202 |
Mlt fam grp bhv train 1st 60 |
Bundled |
|
96203 |
Mlt fam grp bhv train ea add |
Bundled |
|
98978 |
Rem ther mntr dev sply cbt |
By Report |
|
99418 |
Prolng ip/obs e/m ea 15 min |
Section 9789.12.3. establishes payment conditions |
|
0004A |
Adm sarscov2 30mcg/0.3ml bst |
By Report |
|
0034A |
Adm sarscov2 vac ad26 .5ml b |
By Report |
|
0044A |
Adm sarscov2 5mcg/0.5ml bst |
By Report |
|
0051A |
Adm sarscv2 30mcg trs-sucr 1 |
By Report |
|
0052A |
Adm sarscv2 30mcg trs-sucr 2 |
By Report |
|
0053A |
Adm sarscv2 30mcg trs-sucr 3 |
By Report |
|
0054A |
Adm sarscv2 30mcg trs-sucr b |
By Report |
|
0064A |
Adm sarscov2 50mcg/0.25mlbst |
By Report |
|
0073A |
Adm sarscv2 10mcg trs-sucr 3 |
By Report |
|
0124A |
Adm sarscv2 bvl 30mcg/.3ml b |
By Report |
|
0134A |
Adm sarscv2 bvl 50mcg/.5ml b |
By Report |
|
0144A |
Adm srscv2 bvl 25mcg/.25ml b |
By Report |
|
0154A |
Adm sarscv2 bvl 10mcg/.2ml b |
By Report |
|
0738T |
Tx pln mag fld abltj prst8 |
By Report |
|
0739T |
Abltj mal prst8 mag fld ndct |
By Report |
|
0740T |
Rem auton alg nsln cal setup |
By Report |
|
0741T |
Rem auton alg nsln data coll |
By Report |
|
0742T |
26 |
Aqmbf spect xers/strs & rest |
By Report |
0742T |
TC |
Aqmbf spect xers/strs & rest |
By Report |
0742T |
Aqmbf spect xers/strs & rest |
By Report |
|
0743T |
B1 str & fx rsk vrt fx assmt |
By Report |
|
0744T |
Insj bioprostc vlv fem vn |
By Report |
|
0745T |
Car ablt rad arr n-invas loc |
By Report |
|
0746T |
Car ablt rad arr cnv loc map |
By Report |
|
0747T |
Car ablt rad arrhyt dlvr rad |
By Report |
|
0748T |
Njx stm cl prdct anl sft tis |
By Report |
|
0749T |
B1 str&fx rsk assmt dxr-bmd |
By Report |
|
0750T |
B1 str&fx rsk asmt dxrbmd1vw |
By Report |
|
0751T |
Dgtz gls mcrscp sld level ii |
By Report |
|
0752T |
Dgtz gls mcrscp sld lvl iii |
By Report |
|
0753T |
Dgtz gls mcrscp sld level iv |
By Report |
|
0754T |
Dgtz gls mcrscp sld level v |
By Report |
|
0755T |
Dgtz gls mcrscp sld level vi |
By Report |
|
0756T |
Dgtz gls mcrscp sld spc grpi |
By Report |
|
0757T |
Dgtz gls mcrscp sl spc grpii |
By Report |
|
0758T |
Dgtz gls mcrscp sl spc hchem |
By Report |
|
0759T |
Dgtz gls mcrscp sl sp grpiii |
By Report |
|
0760T |
Dgtz gls mcrscp sl imm 1st |
By Report |
|
0761T |
Dgtz gls mcrscp sl imm ea 1 |
By Report |
|
0762T |
Dgtz gls mcrscp sl imm ea m |
By Report |
|
0763T |
Dgtz gls mcrscp mphmtrc alys |
By Report |
|
0764T |
Asstv alg ecg rsk asmt cncrt |
By Report |
|
0765T |
Asstv alg ecg rsk asmt prev |
By Report |
|
0766T |
Tc mag stimj pn 1st tx 1nrv |
By Report |
|
0767T |
Tc mag stimj pn 1st tx ea |
By Report |
|
0768T |
Tc mag stimj pn sbsq tx 1nrv |
By Report |
|
0769T |
Tc mag stimj pn sbsq tx ea |
By Report |
|
0770T |
Vr technology assist therapy |
By Report |
|
0771T |
Vr px dissoc svc sm phy 1st |
By Report |
|
0772T |
Vr px dissoc svc sm phy ea |
By Report |
|
0773T |
Vr px dissoc svc oth phy 1st |
By Report |
|
0774T |
Vr px dissoc svc oth phy ea |
By Report |
|
0775T |
Arthrd si jt prq iartic impl |
By Report |
|
0776T |
Ther indctj ntrabrn hypthrm |
By Report |
|
0777T |
R-t prs sensing edrl gdn sys |
By Report |
|
0777T |
26 |
R-t prs sensing edrl gdn sys |
By Report |
0777T |
TC |
R-t prs sensing edrl gdn sys |
By Report |
0778T |
Smmg cncrnt appl imu snr |
By Report |
|
0779T |
TC |
Gi myoelectrical actv study |
By Report |
0779T |
Gi myoelectrical actv study |
By Report |
|
0779T |
26 |
Gi myoelectrical actv study |
By Report |
0780T |
Instlj fecal microbiota ssp |
By Report |
|
0781T |
Brnchsc rf dstrj pulm nrv bi |
By Report |
|
0782T |
Brnchsc rf dstrj plm nrv uni |
By Report |
|
0783T |
Tc auriculr neurostimulation |
By Report |
|
A2014 |
Omeza collag per 100 mg |
By Report |
|
A2015 |
Phoenix wnd mtrx, per sq cm |
By Report |
|
A2016 |
Permeaderm b, per sq cm |
By Report |
|
A2017 |
Permeaderm glove, each |
By Report |
|
A2018 |
Permeaderm c, per sq cm |
By Report |
|
A4239 |
Non-adju cgm supply allow |
Bundled |
|
A4596 |
Ces system monthly supp |
RVU+GPCI+CF |
|
D0210 |
26 |
Intraor comprehensive series |
By Report |
D0210 |
TC |
Intraor comprehensive series |
By Report |
D0220 |
26 |
Intraoral periapical first |
By Report |
D0220 |
TC |
Intraoral periapical first |
By Report |
D0230 |
26 |
Intraoral periapical ea add |
By Report |
D0230 |
TC |
Intraoral periapical ea add |
By Report |
D0240 |
TC |
Intraoral occlusal film |
By Report |
D0240 |
26 |
Intraoral occlusal film |
By Report |
D0250 |
26 |
Extraoral 2d project image |
By Report |
D0250 |
TC |
Extraoral 2d project image |
By Report |
D0251 |
26 |
Extraoral posterior image |
By Report |
D0251 |
TC |
Extraoral posterior image |
By Report |
D0270 |
TC |
Dental bitewing single image |
By Report |
D0270 |
26 |
Dental bitewing single image |
By Report |
D0272 |
26 |
Dental bitewings two images |
By Report |
D0272 |
TC |
Dental bitewings two images |
By Report |
D0273 |
TC |
Bitewings - three images |
By Report |
D0273 |
26 |
Bitewings - three images |
By Report |
D0274 |
TC |
Bitewings four images |
By Report |
D0274 |
26 |
Bitewings four images |
By Report |
D0277 |
TC |
Vert bitewings 7 to 8 images |
By Report |
D0277 |
26 |
Vert bitewings 7 to 8 images |
By Report |
D0310 |
26 |
Dental saliography |
By Report |
D0310 |
TC |
Dental saliography |
By Report |
D0320 |
26 |
Dental tmj arthrogram incl i |
By Report |
D0320 |
TC |
Dental tmj arthrogram incl i |
By Report |
D0321 |
26 |
Other tmj images by report |
By Report |
D0321 |
TC |
Other tmj images by report |
By Report |
D0322 |
26 |
Dental tomographic survey |
By Report |
D0322 |
TC |
Dental tomographic survey |
By Report |
D0330 |
26 |
Panoramic image |
By Report |
D0330 |
TC |
Panoramic image |
By Report |
D0340 |
26 |
2d cephalometric image |
By Report |
D0340 |
TC |
2d cephalometric image |
By Report |
D0350 |
TC |
Oral/facial photo images |
By Report |
D0350 |
26 |
Oral/facial photo images |
By Report |
D0364 |
TC |
Cone beam ct capt & interp |
By Report |
D0364 |
26 |
Cone beam ct capt & interp |
By Report |
D0365 |
26 |
Cone beam ct interprete man |
By Report |
D0365 |
TC |
Cone beam ct interprete man |
By Report |
D0366 |
TC |
Cone beam ct interprete max |
By Report |
D0366 |
26 |
Cone beam ct interprete max |
By Report |
D0367 |
TC |
Cone beam ct interp both jaw |
By Report |
D0367 |
26 |
Cone beam ct interp both jaw |
By Report |
D0368 |
26 |
Cone beam ct interprete tmj |
By Report |
D0368 |
TC |
Cone beam ct interprete tmj |
By Report |
D0369 |
26 |
Max mri capture & interprete |
By Report |
D0369 |
TC |
Max mri capture & interprete |
By Report |
D0370 |
26 |
Max ultrasound capt & interp |
By Report |
D0370 |
TC |
Max ultrasound capt & interp |
By Report |
D0371 |
TC |
Sialoendoscopy capt & interp |
By Report |
D0371 |
26 |
Sialoendoscopy capt & interp |
By Report |
D0372 |
26 |
Tomo comp series images |
By Report |
D0372 |
Tomo comp series images |
By Report |
|
D0372 |
TC |
Tomo comp series images |
By Report |
D0373 |
Tomo bitewing image |
By Report |
|
D0373 |
TC |
Tomo bitewing image |
By Report |
D0373 |
26 |
Tomo bitewing image |
By Report |
D0374 |
Tomo periapical image |
By Report |
|
D0374 |
26 |
Tomo periapical image |
By Report |
D0374 |
TC |
Tomo periapical image |
By Report |
D0380 |
TC |
Cone beam ct capture limited |
By Report |
D0380 |
26 |
Cone beam ct capture limited |
By Report |
D0381 |
TC |
Cone beam ct capt mandible |
By Report |
D0381 |
26 |
Cone beam ct capt mandible |
By Report |
D0382 |
26 |
Cone beam ct capt maxilla |
By Report |
D0382 |
TC |
Cone beam ct capt maxilla |
By Report |
D0383 |
26 |
Cone beam ct both jaws |
By Report |
D0383 |
TC |
Cone beam ct both jaws |
By Report |
D0384 |
26 |
Cone beam ct capture tmj |
By Report |
D0384 |
TC |
Cone beam ct capture tmj |
By Report |
D0385 |
TC |
Max mri image capture |
By Report |
D0385 |
26 |
Max mri image capture |
By Report |
D0386 |
TC |
Max ultrasound image capture |
By Report |
D0386 |
26 |
Max ultrasound image capture |
By Report |
D0387 |
26 |
Comp image capture only |
By Report |
D0387 |
Comp image capture only |
By Report |
|
D0387 |
TC |
Comp image capture only |
By Report |
D0388 |
TC |
Bitewing image capture only |
By Report |
D0388 |
26 |
Bitewing image capture only |
By Report |
D0388 |
Bitewing image capture only |
By Report |
|
D0389 |
TC |
Periopic image capture only |
By Report |
D0389 |
Periopic image capture only |
By Report |
|
D0389 |
26 |
Periopic image capture only |
By Report |
D0391 |
26 |
Imterprete diagnostic image |
By Report |
D0391 |
TC |
Imterprete diagnostic image |
By Report |
D0393 |
TC |
Trtmnt simulation 3d image |
By Report |
D0393 |
26 |
Trtmnt simulation 3d image |
By Report |
D0394 |
TC |
Digital sub 2 or more images |
By Report |
D0394 |
26 |
Digital sub 2 or more images |
By Report |
D0395 |
TC |
Fusion 2 or more 3d images |
By Report |
D0395 |
26 |
Fusion 2 or more 3d images |
By Report |
D0475 |
TC |
Decalcification procedure |
By Report |
D0475 |
26 |
Decalcification procedure |
By Report |
D0478 |
26 |
Immunohistochemical stains |
By Report |
D0478 |
TC |
Immunohistochemical stains |
By Report |
D0480 |
26 |
Cytopath smear prep & report |
By Report |
D0480 |
TC |
Cytopath smear prep & report |
By Report |
D0481 |
26 |
Electron microscopy |
By Report |
D0481 |
TC |
Electron microscopy |
By Report |
D0484 |
TC |
Consult slides prep elsewher |
By Report |
D0484 |
26 |
Consult slides prep elsewher |
By Report |
D0485 |
TC |
Consult inc prep of slides |
By Report |
D0485 |
26 |
Consult inc prep of slides |
By Report |
D0605 |
TC |
Antibody test pub hlth path |
By Report |
D0605 |
26 |
Antibody test pub hlth path |
By Report |
D0701 |
26 |
Pano radio image |
By Report |
D0701 |
TC |
Pano radio image |
By Report |
D0702 |
TC |
2d cephal radio image |
By Report |
D0702 |
26 |
2d cephal radio image |
By Report |
D0703 |
26 |
2d oral/facial photo image |
By Report |
D0703 |
TC |
2d oral/facial photo image |
By Report |
D0705 |
26 |
Extra oral post radio image |
By Report |
D0705 |
TC |
Extra oral post radio image |
By Report |
D0706 |
TC |
Intraoral occlus radio image |
By Report |
D0706 |
26 |
Intraoral occlus radio image |
By Report |
D0707 |
TC |
Intraoral periap radio image |
By Report |
D0707 |
26 |
Intraoral periap radio image |
By Report |
D0708 |
TC |
Intraoral bite radio image |
By Report |
D0708 |
26 |
Intraoral bite radio image |
By Report |
D0709 |
TC |
Intraoral comp image capture |
By Report |
D0709 |
26 |
Intraoral comp image capture |
By Report |
D0801 |
3d dental scan direct |
By Report |
|
D0801 |
26 |
3d dental scan direct |
By Report |
D0801 |
TC |
3d dental scan direct |
By Report |
D0802 |
3d dental scan indirect |
By Report |
|
D0802 |
26 |
3d dental scan indirect |
By Report |
D0802 |
TC |
3d dental scan indirect |
By Report |
D0803 |
26 |
3d facial scan direct |
By Report |
D0803 |
3d facial scan direct |
By Report |
|
D0803 |
TC |
3d facial scan direct |
By Report |
D0804 |
26 |
3d facial scan indirect |
By Report |
D0804 |
3d facial scan indirect |
By Report |
|
D0804 |
TC |
3d facial scan indirect |
By Report |
D1781 |
Vac admin human pap dose 1 |
By Report |
|
D1782 |
Vac admin human pap dose 2 |
By Report |
|
D1783 |
Vac admin human pap dose 3 |
By Report |
|
D4286 |
Remove non-resorb barrier |
By Report |
|
D6105 |
Remove implant body |
By Report |
|
D6106 |
Tissue regen resorbable |
By Report |
|
D6107 |
Tissue regen non-resorbable |
By Report |
|
D6197 |
Replace material prosthesis |
By Report |
|
D7509 |
Marsupialization odon cyst |
By Report |
|
D7956 |
Tiss regen edent resorb |
By Report |
|
D7957 |
Tiss regen edent nonresorb |
By Report |
|
D9953 |
Reline sleep apnea appliance |
By Report |
|
G0316 |
Prolong inpt eval add15 m |
RVU+GPCI+CF |
|
G0317 |
Prolong nursin fac eval 15m |
RVU+GPCI+CF |
|
G0318 |
Prolong home eval add 15m |
RVU+GPCI+CF |
|
G0320 |
Two-way audio and video hhs |
By Report |
|
G0321 |
Audio-only hhs |
By Report |
|
G0322 |
Home h physio data collec tr |
By Report |
|
G0323 |
Care manage beh svs 20mins |
RVU+GPCI+CF |
|
G0330 |
Facility svs dental rehab |
By Report |
|
G3002 |
Chronic pain mgmt 30 mins |
RVU+GPCI+CF |
|
G3003 |
Chronic pain mgmt addl 15m |
RVU+GPCI+CF |
|
J0134 |
Inj acetaminophen -fresenius |
RVU+GPCI+CF |
|
J0136 |
Inj, acetaminophen (b braun) |
RVU+GPCI+CF |
|
J0173 |
Inj, epinephrine (belcher) |
By Report |
|
J0225 |
Inj, vutrisiran, 1 mg |
RVU+GPCI+CF |
|
J0283 |
Inj, amiodarone (nexterone) |
RVU+GPCI+CF |
|
J0611 |
Calcium glucon (wg critical) |
RVU+GPCI+CF |
|
J0689 |
Inj cefazolin sodium, baxter |
RVU+GPCI+CF |
|
J0701 |
Inj. cefepime hcl (baxter) |
RVU+GPCI+CF |
|
J0703 |
Inj, cefepime hcl (b braun) |
RVU+GPCI+CF |
|
J0877 |
Inj, daptomycin (hospira) |
RVU+GPCI+CF |
|
J0891 |
Argatroban nonesrd (accord) |
RVU+GPCI+CF |
|
J0892 |
Argatroban dialysis (accord) |
RVU+GPCI+CF |
|
J0893 |
Inj, decitabine (sun pharma) |
RVU+GPCI+CF |
|
J0898 |
Argatroban nonesrd (auromed) |
RVU+GPCI+CF |
|
J0899 |
Argatroban dialysis, auromed |
RVU+GPCI+CF |
|
J1456 |
Inj, fosaprepitant (teva) |
RVU+GPCI+CF |
|
J1574 |
Inj, ganciclovir (exela) |
RVU+GPCI+CF |
|
J1611 |
Inj glucagon hcl, fresenius |
RVU+GPCI+CF |
|
J1643 |
Inj heparin, pfizer, 1000u |
RVU+GPCI+CF |
|
J1954 |
Inj lutrate depot 7.5 mg |
By Report |
|
J2021 |
Inj, linezolid (hospira) |
RVU+GPCI+CF |
|
J2184 |
Inj, meropenem (b. braun) |
RVU+GPCI+CF |
|
J2247 |
Inj, micafungin (par pharm) |
RVU+GPCI+CF |
|
J2251 |
Inj midazolam (wg crit care) |
RVU+GPCI+CF |
|
J2272 |
Inj, morphine (fresenius) |
RVU+GPCI+CF |
|
J2281 |
Inj moxifloxacin (fres kabi) |
RVU+GPCI+CF |
|
J2311 |
Inj, naloxone hcl (zimhi) |
RVU+GPCI+CF |
|
J2327 |
Inj risankizumab-rzaa 1 mg |
RVU+GPCI+CF |
|
J2401 |
Chloroprocaine hcl injection |
RVU+GPCI+CF |
|
J2402 |
Chloroprocaine (clorotekal) |
RVU+GPCI+CF |
|
J3244 |
Inj. tigecycline (accord) |
RVU+GPCI+CF |
|
J3371 |
Inj, vancomycin hcl (mylan) |
RVU+GPCI+CF |
|
J3372 |
Inj, vancomycin hcl (xellia) |
RVU+GPCI+CF |
|
J9046 |
Inj, bortezomib, dr. reddy's |
RVU+GPCI+CF |
|
J9048 |
Inj, bortezomib freseniuskab |
RVU+GPCI+CF |
|
J9049 |
Inj, bortezomib, hospira |
RVU+GPCI+CF |
|
J9314 |
Inj pemetrexed (teva) 10mg |
RVU+GPCI+CF |
|
J9393 |
Inj, fulvestrant (teva) |
RVU+GPCI+CF |
|
J9394 |
Inj, fulvestrant (fresenius) |
RVU+GPCI+CF |
|
M0001 |
Advancing cancer care mvp |
Reporting purposes only |
|
M0002 |
Opt care kidney hlth mvp |
Reporting purposes only |
|
M0003 |
Opt care episod neuro mvp |
Reporting purposes only |
|
M0004 |
Support care neur cond mvp |
Reporting purposes only |
|
M0005 |
Promot wellness mvp |
Reporting purposes only |
|
M1150 |
Lvef <=40% or mod/sev l vsf |
Reporting purposes only |
|
M1151 |
Pt w/ hx trnsplt or lvad |
Reporting purposes only |
|
M1152 |
Pt w/ hx trnsplt or lvad |
Reporting purposes only |
|
M1153 |
Pt w/ dx osteo doe |
Reporting purposes only |
|
M1154 |
Hospc serv dur meas pd |
Reporting purposes only |
|
M1155 |
Pt anphx due to pneum |
Reporting purposes only |
|
M1156 |
Pt recd actv chemo any time |
Reporting purposes only |
|
M1157 |
Pt recd bone mar trnsplt |
Reporting purposes only |
|
M1158 |
Pt hx immcomp prior/dur pd |
Reporting purposes only |
|
M1159 |
Hospc serv dur meas pd |
Reporting purposes only |
|
M1160 |
Pt anphx due to mengb bef 13 |
Reporting purposes only |
|
M1161 |
Pt anphx due to dtp bef 13 |
Reporting purposes only |
|
M1162 |
Pt enceph due to dtp bef 13 |
Reporting purposes only |
|
M1163 |
Pt anphx due to hpv bef 13 |
Reporting purposes only |
|
M1164 |
Pt w/ dementia any time |
Reporting purposes only |
|
M1165 |
Pt use hspc dur meas pd |
Reporting purposes only |
|
M1166 |
Path rpt tis spec wle/reexc |
Reporting purposes only |
|
M1167 |
Hspc dur meas pd |
Reporting purposes only |
|
M1168 |
Pt recd flu vax 7/1-6/30 |
Reporting purposes only |
|
M1169 |
Doc med rsn no flu vax |
Reporting purposes only |
|
M1170 |
Pt w/o flu vax 7/1-6/30 |
Reporting purposes only |
|
M1171 |
Pt recd 1 td/tdap 9yrs prior |
Reporting purposes only |
|
M1172 |
Doc med rsn no td/tdap |
Reporting purposes only |
|
M1173 |
Pt no rec td/tdap 9yrs prior |
Reporting purposes only |
|
M1174 |
Pt w/ 1 hzv lv or 2 hzv recm |
Reporting purposes only |
|
M1175 |
Doc med rsn no hzv |
Reporting purposes only |
|
M1176 |
Pt w/o hzv on/aft age 50 |
Reporting purposes only |
|
M1177 |
Pt recd pcv on/aft 60 |
Reporting purposes only |
|
M1178 |
Doc med rsn no pcv |
Reporting purposes only |
|
M1179 |
No pcv recd |
Reporting purposes only |
|
M1180 |
Pt imm ckpt inhib therapy |
Reporting purposes only |
|
M1181 |
Gr 2 or> dia or gr2 or> col |
Reporting purposes only |
|
M1182 |
Not elg pre ex ibd/uc/crohn |
Reporting purposes only |
|
M1183 |
Doc imm ckpt inhib hld |
Reporting purposes only |
|
M1184 |
Doc med rsn no cst/ist rx |
Reporting purposes only |
|
M1185 |
Imm ckpt inhib not hld no rx |
Reporting purposes only |
|
M1186 |
Pt w/ rx for hspc/plltv care |
Reporting purposes only |
|
M1187 |
Pt w/ esrd |
Reporting purposes only |
|
M1188 |
Pt w/ ckd stg 5 |
Reporting purposes only |
|
M1189 |
Doc khe pef w/efgr/uacr |
Reporting purposes only |
|
M1190 |
Doc khe not pef w/efgr/uacr |
Reporting purposes only |
|
M1191 |
Hspc svc any time in meas pd |
Reporting purposes only |
|
M1192 |
Pt w/ dx sq cell ca of esoph |
Reporting purposes only |
|
M1193 |
Rpts w/ imp/con mmr/msi |
Reporting purposes only |
|
M1194 |
Med rsn no imp/con mmr/msi |
Reporting purposes only |
|
M1195 |
Rpt wo imp/con mmr/msi |
Reporting purposes only |
|
M1196 |
Ixv nrs vrs iqa >=4 |
Reporting purposes only |
|
M1197 |
Isa red >=2 fr ixv |
Reporting purposes only |
|
M1198 |
Isa not red 2pts fr ixv |
Reporting purposes only |
|
M1199 |
Pt rec'g rrt |
Reporting purposes only |
|
M1200 |
Ace-i/arb rx |
Reporting purposes only |
|
M1201 |
Med rsn no ace-i/arb rx |
Reporting purposes only |
|
M1202 |
Pt rsn no ace-i/arb rx |
Reporting purposes only |
|
M1203 |
No rsn ace-i/arb rx |
Reporting purposes only |
|
M1204 |
Ixv nrs vrs iqa >=4 |
Reporting purposes only |
|
M1205 |
Isa red >=2 fr ixv |
Reporting purposes only |
|
M1206 |
Isa not red 2pts fr ixv |
Reporting purposes only |
|
M1207 |
#pts scrn sdoh |
Reporting purposes only |
|
M1208 |
#pts no scrn sdoh |
Reporting purposes only |
|
M1209 |
>=2 same hi-rsk med w/o diag |
Reporting purposes only |
|
M1210 |
>=2 same meds tbl4 not ord |
Reporting purposes only |
|
Q4236 |
Carepatch per sq cm |
By Report |
|
Q4262 |
Dual layer impax, per sq cm |
By Report |
|
Q4263 |
Surgraft tl, per sq cm |
By Report |
|
Q4264 |
Cocoon membrane, per sq cm |
By Report |
|
Q5126 |
Inj alymsys 10 mg |
By Report |
|
T1032 |
Sv doula brth wrk per 15 min |
By Report |
|
T1033 |
Sv doula brth wrk per diem |
By Report |
2023 Deleted HCPCS Codes for CA Workers’ Comp
The update to the Physician Fee Schedule deletes 125 procedure codes. As listed below, these codes are no longer assigned any reimbursement by the DWC.
HCPCS |
Modifier |
Description |
15850 |
Remove sutures same surgeon |
|
49560 |
Rpr ventral hern init reduc |
|
49561 |
Rpr ventral hern init block |
|
49565 |
Rerepair ventrl hern reduce |
|
49566 |
Rerepair ventrl hern block |
|
49568 |
Hernia repair w/mesh |
|
49570 |
Rpr epigastric hern reduce |
|
49572 |
Rpr epigastric hern blocked |
|
49580 |
Rpr umbil hern reduc < 5 yr |
|
49582 |
Rpr umbil hern block < 5 yr |
|
49585 |
Rpr umbil hern reduc > 5 yr |
|
49587 |
Rpr umbil hern block > 5 yr |
|
49590 |
Repair spigelian hernia |
|
49652 |
Lap vent/abd hernia repair |
|
49653 |
Lap vent/abd hern proc comp |
|
49654 |
Lap inc hernia repair |
|
49655 |
Lap inc hern repair comp |
|
49656 |
Lap inc hernia repair recur |
|
49657 |
Lap inc hern recur comp |
|
92284 |
TC |
Dark adaptation eye exam |
92284 |
26 |
Dark adaptation eye exam |
99217 |
Observation care discharge |
|
99218 |
Initial observation care |
|
99219 |
Initial observation care |
|
99220 |
Initial observation care |
|
99224 |
Subsequent observation care |
|
99225 |
Subsequent observation care |
|
99226 |
Subsequent observation care |
|
99241 |
Office consultation |
|
99251 |
Inpatient consultation |
|
99318 |
Annual nursing fac assessmnt |
|
99324 |
Domicil/r-home visit new pat |
|
99325 |
Domicil/r-home visit new pat |
|
99326 |
Domicil/r-home visit new pat |
|
99327 |
Domicil/r-home visit new pat |
|
99328 |
Domicil/r-home visit new pat |
|
99334 |
Domicil/r-home visit est pat |
|
99335 |
Domicil/r-home visit est pat |
|
99336 |
Domicil/r-home visit est pat |
|
99337 |
Domicil/r-home visit est pat |
|
99339 |
Domicil/r-home care supervis |
|
99340 |
Domicil/r-home care supervis |
|
99343 |
Home visit new patient |
|
99354 |
Prolng svc o/p 1st hour |
|
99355 |
Prolng svc o/p ea addl 30 |
|
99356 |
Prolng svc i/p/obs 1st hour |
|
99357 |
Prolng svc i/p/obs ea addl |
|
0163T |
Tot disc arthrp ea addl lmbr |
|
0312T |
Laps impltj nstim vagus |
|
0313T |
Laps rmvl nstim array vagus |
|
0314T |
Laps rmvl vgl arry&pls gen |
|
0315T |
Rmvl vagus nerve pls gen |
|
0316T |
Replc vagus nerve pls gen |
|
0317T |
Elec alys vagus nrv pls gen |
|
0470T |
26 |
Oct skn img acquisj i&r 1st |
0470T |
Oct skn img acquisj i&r 1st |
|
0470T |
TC |
Oct skn img acquisj i&r 1st |
0471T |
Oct skn img acquisj i&r addl |
|
0471T |
26 |
Oct skn img acquisj i&r addl |
0471T |
TC |
Oct skn img acquisj i&r addl |
0475T |
Rec ftl car sgl 3 ch i&r |
|
0476T |
Rec ftl car sgl elec tr data |
|
0477T |
Rec ftl car sgl xrtj alys |
|
0478T |
Rec ftl car 3 ch rev i&r |
|
0487T |
Trvg biomchn mapg w/reprt |
|
0491T |
Abl lsr opn wnd 1st 20 sqcm |
|
0492T |
Abl lsr opn wnd addl 20 sqcm |
|
0493T |
Cntc near ifr spectrsc wound |
|
0497T |
Xtrnl pt act ecg in-off conn |
|
0498T |
Xtrnl pt act ecg r&i pr 30 d |
|
0514T |
Intraop vis axis id pt fixj |
|
0702T |
Rem ther mntr ol tech sprt |
|
0703T |
Rem ther mntr ol cog bhv |
|
A9574 |
Air poly intrauterine foam |
|
D0351 |
3d photographic image |
|
D0704 |
3d photo image capture only |
|
G0028 |
Doc med rsn no scr tob |
|
G0308 |
180 d implant glucose sensor |
|
G0309 |
Rem/inseráglu sensor dif sit |
|
G1009 |
Cdsm sage health |
|
G2095 |
Sys rsn no ace arn arni |
|
G2170 |
Avf by tissue w thermal e |
|
G2171 |
Avf use magnetic/art/ven |
|
G2198 |
Med rsn no unhlthy etoh |
|
G2201 |
Med rsn no brief couns |
|
G2203 |
Med rsn no etoh couns |
|
G9196 |
Med reason for no ceph |
|
G9197 |
Order for ceph |
|
G9198 |
No order for ceph no reason |
|
G9250 |
Doc of pain comfort 48hr |
|
G9251 |
Doc no pain comfort 48hr |
|
G9359 |
Neg mgd pos tb notact |
|
G9360 |
No doc of neg or man pos tb |
|
G9506 |
Bio imm resp mod presc |
|
G9618 |
Doc scr uter mal or us/samp |
|
G9620 |
No scr utr malig/us/samp rng |
|
G9623 |
Doc med rsn no scr etoh use |
|
G9631 |
Pt ui srg 30 day pst srg |
|
G9632 |
Med rsn for no rpt uret inj |
|
G9633 |
Pt no ui srg 30 day pst srg |
|
G9678 |
Oncology care model service |
|
G9718 |
Hospice anytime msmt per |
|
G9774 |
Pt had hyst |
|
G9778 |
Pts dx w/pregn |
|
G9808 |
Pt no asthm cont med mst per |
|
G9809 |
Pt w/hosp anytime msmt per |
|
G9810 |
Pdc 75% w/asth cont med |
|
G9811 |
No pdc 75% w/asth cont med |
|
G9904 |
Doc med rsn no tbco scrn |
|
G9907 |
Doc med rsn no tbco interv |
|
G9909 |
Doc med rsn no tbco interv |
|
G9932 |
Doc pt rsn no tb scrn recrds |
|
G9942 |
Adtl spine proc on same date |
|
G9948 |
Adtl spine proc on same date |
|
G9989 |
Med rsn no pneum vax |
|
J2400 |
Chloroprocaine hcl injection |
|
J9044 |
Inj, bortezomib, nos, 0.1 mg |
|
M1017 |
Pt admt to palitve serv |
|
M1071 |
Pt had add'l sp pcr perf |
|
M1145 |
Mfn drug add-on, per dose |
|
U0001 |
2019-ncov diagnostic p |
|
U0002 |
Covid-19 lab test non-cdc |
|
U0003 |
Cov-19 amp prb hgh thruput |
|
U0004 |
Cov-19 test non-cdc hgh thru |
|
U0005 |
Infec agen detec ampli probe |
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