CA OMFS Update: 2022 'WC' Billing Codes

CA OMFS Update: 2022 'WC' Billing Codes

California’s Division of Workers’ Compensation (DWC) announced reimbursement updates to the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS), effective for services rendered on or after January 1, 2022.

The update order and related documents can be found at the DWC website’s OMFS page. The updates conform the OMFS to the Centers for Medicare and Medicaid Services (CMS) payment system, as required by California Labor Code section 5307.1.

Below is a list of the increased rates for California-specific procedure codes.

Make calculating 2022 OMFS reimbursements easy: Try our OMFS Calculator for accurate, instant, always-updated rates (Fee Schedules: California, New York and US DOL).

California-Specific Codes: Reimbursement Increase

California Code of Regulations Section 9789.12.14 establishes “California Specific Codes,” which begin with the prefix “WC.” Physicians report these codes when submitting reports or furnishing copies of chart notes, x-rays or scans.

For example, a primary treating physician should bill WC002 when submitting the required PR-2 progress report for an injured worker. The reimbursement owed to the provider reporting the  WC002 is now $13.99 (for 2021 dates of service, the reimbursement for WC002 is $13.70)

Annually, the DWC establishes new statewide reimbursement rates for these ‘WC’ codes. The table below outlines the reimbursement rates due for all dates of service on or after January 1, 2022.

California-Specific Billing Code

Description

Reimbursement Amount

Additional Page Reimbursement

WC001

Doctor’s First Report of Occupational Illness or Injury (Form 5021)

Not reimbursable

n/a (not applicable)

WC002

Primary Treating Physician’s Progress Report (Form PR-2)

$13.99

n/a

WC003

Primary Treating Physician’s Permanent & Stationary Report (Form PR-3)

$43.32 for first page

$26.64 each additional page. Maximum of six pages absent mutual agreement ($176.52)

WC004

Primary Treating Physician’s Permanent & Stationary Report (Form PR-4)

$43.32 for first page

$26.64 each additional page. Maximum of seven pages absent mutual agreement ($203.16)

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report

$43.32 for first page

$26.64 each additional page. Maximum of six pages absent mutual agreement ($176.52)

WC007

Consultation Reports requested by the WCAB or the Administrative Director

$43.32 for first page

$26.64 each additional page. Maximum of six pages absent mutual agreement ($176.52)

WC008

Chart Notes

$12.51 for up to the first 15 pages

$0.26 for each additional page after the first 15 pages

WC009

Duplicate Reports

$12.51 for up to the first 15 pages

$0.26 for each additional page after the first 15 pages

WC010

Duplication of X-Ray

$5.74 per x-ray

n/a

WC011

Duplication of Scan

$12.51 per scan

n/a

WC012

Missed Appointments. This code is designated for communication only. It does not imply that compensation is owed. Non-reimbursable absent agreement.

No Fee Prescribed/Non Reimbursable absent agreement

n/a

We’ll keep readers up to date on further fee schedule changes, in this space.


We keep track of the OMFS so you don’t have to. Try our DaisyWizard OMFS Calculator free, and see how much easier workers’ comp billing can be.

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