CA OMFS Update: Physician Services (Q3 2023)

July 10, 2023 4 min read

By: the daisyNews Team

CA OMFS Update: Physician Services (Q3 2023)

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 July 1, 2023.

The update adds 89 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!

89 New HCPCS Codes

Listed below are the new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for Q3 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.

Q3 2023 New HCPCS Codes for CA Workers’ Comp Physician Services

HCPCS	Description	Reimbursement
A2019	Kerecis marigen shld sq cm	By Report
A2020	Ac5 wound system	By Report
A2021	Neomatrix per sq cm	By Report
A4341	Iduc valve pat inst repl	RVU+GPCI+CF
A4342	Iduc valve sply repl	RVU+GPCI+CF
A4560	Nmes disposable	By Report
A6590	Urinary cath disp suc pump	RVU+GPCI+CF
A6591	Urinary cath suc pump	RVU+GPCI+CF
A7049	Epap nasal valve	By Report
J0137	Inj, acetaminophen (hikma)	By Report
J0206	Inj allopurinol sodium 1 mg	By Report
J0216	Inj, alfentanil hcl, 500mcg	By Report
J0457	Injection, aztreonam, 100 mg	By Report
J0665	Inj, bupivacaine, nos, 0.5mg	By Report
J0736	Inj, clindamycin phosp 300mg	By Report
J0737	Inj, clindamycin (baxter)	By Report
J1411	Inj, hemgenix, per tx dose	By Report
J1440	Fecalámicrobiota jslm 1 ml	By Report
J1576	Inj, panzyga, 500 mg	By Report
J1805	Inj, esmolol hcl, 10mg	By Report
J1806	Inj esmolol hcl wg crit care	By Report
J1811	Fiasp for insulin pump use	By Report
J1812	Inj. Insulin (fiasp)	By Report
J1813	Lyumjev for insulin pump use	By Report
J1814	Inj. insulin (lyumjev)	By Report
J1836	Inj, metronidazole, 10 mg	By Report
J1920	Inj, labetalol hcl, 5mg	By Report
J1921	Inj labetalol hcl hikma, 5mg	By Report
J1941	Inj, furoscix, 20 mg	By Report
J1961	Inj, lenacapavir, 1 mg	By Report
J2249	Inj, remimazolam, 1 mg	By Report
J2305	Inj, nitroglycerin, 5 mg	By Report
J2329	Inj ublituximab-xiiy, 1 mg	By Report
J2371	Inj phenylephrine hcl 20 mcg	By Report
J2372	Inj, biorphen, 20 micrograms	By Report
J2427	Inj, invega hafyera/trinza	By Report
J2561	Inj, sezaby, 1 mg	By Report
J2598	Inj, vasopressin, 1 unit	By Report
J2599	Inj vasopressin (am reg) 1 u	By Report
J2806	Inj sincalide, Maia, 5 mcg	By Report
J7213	Inj, ixinity, 1 i.u.	By Report
J9029	Inj, adstiladrin, per tx dos	By Report
J9056	Inj, bendamustine, 1 mg	By Report
J9058	Inj apotex/bendamustine 1 mg	By Report
J9059	Inj bendamustine, baxter 1mg	By Report
J9063	Inj, elahere, 1 mg	By Report
J9259	Paclitaxel (american regent)	By Report
J9321	Inj pemetrexed (sandoz) 10mg	By Report
J9322	Inj pemetrexed (bluepoint)	By Report
J9323	Inj, pemetrexed (hospira) 10	By Report
J9347	Inj, tremelimumab-actl, 1 mg	By Report
J9350	Inj mosunetuzumab-axgb, 1 mg	By Report
J9380	Inj teclistamab cqyv 0.5 mg	By Report
J9381	Inj teplizumab mzwv 5 mcg	By Report
Q4272	Esano a, per sq cm	By Report
Q4273	Esano aaa, per sq cm	By Report
Q4274	Esano ac, per sq cm	By Report
Q4275	Esano aca, per sq cm	By Report
Q4276	Orion, per sq cm	By Report
Q4277	Woundplus e-grat, per sq cm	By Report
Q4278	Epieffect, per sq cm	By Report
Q4280	Xcell amnio matrix per sq cm	By Report
Q4281	Barrera slor dl per sq cm	By Report
Q4282	Cygnus dual per sq cm	By Report
Q4283	Biovance tri or 3l, sq cm	By Report
Q4284	Dermabind sl, per sq cm	By Report
Q5131	Inj, idacio, 20 mg	By Report
S9563	Ht inj immuno diem	By Report
0174A	Adm sarscv2 bvl 3mcg/0.2ml b	By Report
0791T	Motr cog vr gait train ea 15	By Report
0792T	Appl slvr diamn fluoride 38%	By Report
0793T	Prq tcat thrm ablt nrv p-art	By Report
0794T	Pt spec alg rx-onc tx option	By Report
0795T	Tcat ins 2chmbr ldls pm cmpl	By Report
0796T	Tcat ins 2chmbr ldls pm ra	By Report
0797T	Tcat ins 2chmbr ldls pm rv	By Report
0798T	Tcat rmv 2chmbr ldls pm cmpl	By Report
0799T	Tcat rmvl 2chmbr ldls pm ra	By Report
0800T	Tcat rmvl 2chmbr ldls pm rv	By Report
0801T	Tcat rmv&rpl 2chmbr ldls pm	By Report
0802T	Tcat rmv&rpl2chmb ldls pm ra	By Report
0803T	Tcat rmv&rpl2chmb ldls pm rv	By Report
0804T	Prgrmg evl ldls pm 2chmbr ip	By Report
0805T	Tcat s&ivc prstc vl impl prq	By Report
0806T	Tcat s&ivc prstc vl impl opn	By Report
0807T	Pulm tiss vntj alys prev ct	By Report
0808T	Pulm tiss vntj alys w/ct	By Report
0809T	Arthrd si jt prq tfx&implt	By Report
0810T	Subrta njx rx agt w/vtrc	By Report

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3 Reader Comments

York McGavin

daisyNews, thanks for keeping those, toiling away in the trenches, apprised of everything WC related. The addition of the "Readers Comments" function is wonderful, and it will allow others subscribers to provide input, and perhaps suggestions. It would be great if you also added a feature that allows readers to upload documentation.

In particular, I'm looking forward to seeing if the DWC Audit Unit actually conducts any targeted audits as a result of the work you have done, combined with the complaints filed. The last time I saw the DWC Audit Unit take any meaningful action was when Mark Johnson was the Manager -- more than 20 years ago.

Published 03:26PM July 10, 2023

daisyBill Team

How wonderful that York McGavin is daisyNews first commenter. Thanks, York, for the kind words and support and for starting the daisyComments Party.

Rebecca Thompson

daisyNews, thank you for all the work you do to keep providers informed. I especially like your honesty and diligence in researching the issues and reporting on the actual events in our world of insurance compliance (or lack thereof). Your suggestions and recommendations help us navigate the "system". Thank you for adding a "reader comments" section.

Published 06:34PM July 10, 2023

daisyBill Team

Thank you for your kind words. Glad we are helping. daisyBill's mission is to improve workers' comp work for providers so injured workers have access to the best possible care.

Margaret Soberanes

Super BIG thank you to Daisybill for all the hard work you do keeping us informed!!

Published 02:38PM July 11, 2023

daisyBill Team

Thank you for reading daisyNews

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