A new order from the Administrative Director of California’s Division of Workers’ Compensation (DWC) updates the Physician and Non-Physician Practitioner Services portion of the Official Medical Fee Schedule (OMFS).
The reimbursement changes announced on October 2, 2020, are retroactive to dates of service rendered on or after October 1, 2020.
The changes include updates to the RVU files, NCCI Edits, MUEs, and GPCI locality mapping. Note that the updates to the GPCI file do not affect reimbursements.
In Newsline No.: 2020-86, the DWC announced the order to conform the OMFS for Physician Services / Non-Physician Practitioner Services to Medicare’s October fee schedule release and quarterly updates.
These changes are incorporated into California Code of Regulations (CCR) Section 9789.19 and include:
Effective October 1, 2020, the DWC adopted the CMS Medicare National Physician Fee Schedule Relative Value File RVU20D October 1, 2020 quarterly update.
With the adoption of the new RVU file, 22 new billing codes were added: four G-codes, eight J-codes, seven Q-codes, one T-code, one V-code, and 87426, the latter of which is for coronavirus antigen testing.
The OMFS lists the reimbursement for these codes as By Report (BR). For a procedure code where ‘BR’ is listed as the OMFS Expected reimbursement amount, providers must determine a reasonable amount to charge based on comparable procedure codes. CCR § 9789.12.4 offers guidelines to determine an appropriate reimbursement amount for BR codes.
Procedure Code |
Short Description |
OMFS Reimbursement |
G1020 |
Cdsm curbside |
By Report (BR) |
G1021 |
Cdsm ehealthline |
By Report (BR) |
G1022 |
Cdsm intermountain |
By Report (BR) |
G1023 |
Cdsm persivia |
By Report (BR) |
J1437 |
Inj. fe derisomaltose 10 mg |
By Report (BR) |
J1632 |
Inj., brexanolone, 1 mg |
By Report (BR) |
J1738 |
Inj. meloxicam 1 mg |
By Report (BR) |
J3032 |
Inj. eptinezumab-jjmr 1 mg |
By Report (BR) |
J3241 |
Inj. teprotumumab-trbw 10 mg |
By Report (BR) |
J7351 |
Inj bimatoprost itc imp 1mcg |
By Report (BR) |
J9227 |
Inj. isatuximab-irfc 10 mg |
By Report (BR) |
J9304 |
Inj. pemetrexed, 10 mg |
By Report (BR) |
Q4249 |
Amniply, per sq cm |
By Report (BR) |
Q4250 |
AmnioAMP-MP per sq cm |
By Report (BR) |
Q4254 |
Novafix dl per sq cm |
By Report (BR) |
Q4255 |
Reguard, topical use per sq |
By Report (BR) |
Q9001 |
VA chaplain assessment |
By Report (BR) |
Q9002 |
VA chaplain counsel individu |
By Report (BR) |
Q9003 |
VA chaplain counsel group |
By Report (BR) |
T2047 |
Hab prevo waiver per 15 |
By Report (BR) |
V2524 |
Cntct lens hydrophil photoch |
By Report (BR) |
87426 |
Coronavirus ag ia |
By Report (BR) |
In Newsline No.: 2020-86, the DWC also announced the adoption of the CMS ZIP Code to Carrier Locality files October 1, 2020 quarterly update, for GPCI locality mapping. This file did not contain any changes that would affect reimbursements based on GPCI locality mapping.
As always, DaisyBill clients can rest assured that we incorporate the latest changes into our Fee Schedule Calculator. We’ll keep readers updated on any further OMFS changes.
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