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 October 1, 2022.  

The update adds 31 new procedure codes, all reimbursable “By Report.” The update also alters the status of one existing procedure code, without affecting the reimbursement amount.

Read on for details.

31 New HCPCS Codes

The update conforms the OMFS to relevant 2022 fourth quarter changes to the Centers for Medicare and Medicaid Services (CMS) payment system, as required by California Labor Code Section 5307.1. The DWC announced the update in a recent Newsline, and posted the order adopting the update on the DWC website.

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) beginning October 2022. All 31 of the new procedure codes are billable 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.

New HCPCS Codes for CA Workers’ Comp Physician Services

Status Codes Altered

In addition to the above additions, the DWC update alters the Status Codes of one existing procedure code; however, this code remains billable By Report.

Lastly, providers may note that the 2022 Q4 update does not include a new telehealth procedure code list.

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