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 April 1, 2023.

The update adds 27 new procedure codes.

The update conforms the OMFS to relevant 2023 changes in the Medicare 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.

Read on for details!

daisyBill Updated With Latest Changes

daisyBill will instantly reflect the OMFS update when it takes effect next month. For more on how easy workers’ comp billing can be, see the brief video below:

27 New HCPCS Codes

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for Q2 2023.

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

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