2023 CA Physician Fee Schedule Changes

February 14, 2023 19 min read

By: the daisyNews Team

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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