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CA Physician Reimbursements INCREASE as of 7/1/2019

In Newsline No.: 2019-46, the California Division of Workers’ Comp (DWC) announced changes to the Official Medical Fee Schedule for Physician Services / Non-Physician Practitioner Services.

Effective July 1, the DWC adopted the quarterly CMS updates to:

  1. The Relative Value File, which will increase reimbursement for hundreds of surgical CPT codes; and
  2. The Geographic Practice Cost Index (GPCI) locality mapping which includes no reimbursement changes.

Relative Value File

Effective July 1, 2019, the DWC adopted the CMS Medicare National Physician Fee Schedule Relative Value File RVU19C July 1, 2019 quarterly update.

With the adoption of the new RVU file, the largest impact is reimbursement increases for 813 surgical CPT codes.

The table below summarizes the reimbursement changes effective for all dates of service on or after July 1, 2019.

In the past, DaisyBill published the exact reimbursement change. This is no longer possible due to the adoption of GPCI locality mapping effective January 1, 2019.

HCPCS Type

HCPCS Count

Reimbursement Change

CPT Surgical Codes 10004- 69990

90 CPT Codes

INCREASE between 1% - 5.99%

CPT Surgical Codes 10004- 69990

723 CPT Codes

INCREASE between 0.01% - 0.99%

CPT 27035

1 CPT Code

REDUCED by 0.02%

HCPCS - Temporary G Codes

4 G Codes

INCREASED between 0.08% - 0.24%

CPT Medical Procedure Codes

3 CPT Codes

REDUCED between 0.16% - 0.55%

CPT 96440

1 CPT Code

INCREASED by 0.03%

To determine the impact of these reimbursement changes on your practice, subscribe to the DaisyBill Wizard and use the Calculator. It is simple to know the new reimbursements. Plus, you can sign up for a 3-day free trial.

Geographic Pricing Cost Index (GPCI)

Also in Newsline No.: 2019-46, the DWC announced the adoption of the CMS ZIP Code to Carrier Locality files July 1, 2019 quarterly update, for GPCI locality mapping. This file did not contain any changes that would affect reimbursements based on GPCI locality mapping.

For more information on how GPCIs impact reimbursements watch this short video: 9 Minute How-To: Geographic Practice Cost Indices (GPCIs)


We can’t make workers’ comp changes less frequent. We can make it easier to deal with. DaisyBill’s Work Comp Wizard, including our Calculator for seven fee schedules, makes reimbursement changes less of a headache for providers. Start a free trial, and see how.

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