CA OMFS Update: Physician Services (Q3 2024)

July 1, 2024 6 min read

By: the daisyNews Team

CA OMFS Update: Physician Services (Q3 2024)

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, 2024.

The update adds 130 new procedure codes.

The update conforms the OMFS to relevant 2024 Medicare payment system changes, as California Labor Code Section 5307.1 requires. The DWC announced the update in a recent Newsline, and posted the order adopting the update on the DWC website.

daisyBill clients do not need to take any action; we added the new HCPCS to our billing software, which are effective for all dates of service on or after July 1.

Non-daisyBill providers are advised to adjust their systems for dates of services starting July 1.

Read on for details!

DWC Newsline Issued June 18, 2024

The update aligns the OMFS to relevant 2024 changes in the Medicare payment system, as required by California Labor Code Section 5307.1.

Below are the 130 new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for Q3 2024.

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 provides guidelines for appropriate reimbursement amounts for BR codes.

130 New HCPCS Added to Physician Services Fee Schedule

HCPCS	Modifier	Description	Reimbursement Calculation
0640T	TC	Ncntc ifr spctrsc o/t pad 1	By Report
0640T	26	Ncntc ifr spctrsc o/t pad 1	By Report
0859T	26	Ncntc ifr spctrsc o/t pad ea	By Report
0859T	TC	Ncntc ifr spctrsc o/t pad ea	By Report
0867T		Tpla b9 prst8 hyprplsa>=50ml	By Report
0868T	26	Hi-res gastric ep mapping	By Report
0868T	TC	Hi-res gastric ep mapping	By Report
0868T		Hi-res gastric ep mapping	By Report
0869T		Njx b1 sub mtrl hw fixj aug	By Report
0870T		Imp subq prtl ascts pmp sys	By Report
0871T		Rplcmt subq prtl ascites pmp	By Report
0872T		Rplcmt ndwllg bldr&prtl cath	By Report
0873T		Revj subq prtl asct pmp sys	By Report
0874T		Rmvl pertl ascites pmp sys	By Report
0875T		Prgrm subq prtl asct pmp sys	By Report
0876T	TC	Duplex scan hemo fstl lmtd	By Report
0876T	26	Duplex scan hemo fstl lmtd	By Report
0876T		Duplex scan hemo fstl lmtd	By Report
0877T		Augmnt alys ch ct ild w/o ct	By Report
0878T		Augmnt alys ch ct ild w/ct	By Report
0879T		Augmnt alys ch ct ild prep	By Report
0880T		Augmnt alys ch ct ild i&r	By Report
0881T		Cryotherapy oral cavity	By Report
0882T		Intraop ther estim pn ue 1st	By Report
0883T		Intraop ther estim pn ue ea	By Report
0884T		Esphgsc flx 1st tndsc dilat	By Report
0885T		Colsc flx 1st tndsc dilat	By Report
0886T		Sgmdsc flx 1st tndsc dilat	By Report
0887T		End-tidal ctrl inhaled anes	By Report
0888T		Histotripsy mal renal tissue	By Report
0889T		Prsnlz trgt dvl arhfcmrigtbs	By Report
0890T		Arhfcmrigtbs 1st tx day	By Report
0891T		Arhfcmrigtbs sbsq tx day	By Report
0892T		Arhfcmrigtbs sbsq per tx day	By Report
0893T	26	N-invas assmt bld oxygnation	By Report
0893T	TC	N-invas assmt bld oxygnation	By Report
0893T		N-invas assmt bld oxygnation	By Report
0894T		Cannulation liver allograft	By Report
0895T		Connj lvr algrft prfu dev 1	By Report
0896T		Connj lvr algrft prfu dev ea	By Report
0897T	TC	N-invas augmnt arrhyt alys	By Report
0897T		N-invas augmnt arrhyt alys	By Report
0897T	26	N-invas augmnt arrhyt alys	By Report
0898T	TC	N-invas prst8 cancer est map	By Report
0898T	26	N-invas prst8 cancer est map	By Report
0898T		N-invas prst8 cancer est map	By Report
0899T	26	N-invas deter aqmbf aug cmr	By Report
0899T		N-invas deter aqmbf aug cmr	By Report
0899T	TC	N-invas deter aqmbf aug cmr	By Report
0900T	26	N-invas est aqmbf asstv cmr	By Report
0900T	TC	N-invas est aqmbf asstv cmr	By Report
0900T		N-invas est aqmbf asstv cmr	By Report
90637		Vacc qirv mrna 30mcg/.5ml im	By Report
90638		Vacc qirv mrna 60mcg/.5ml im	By Report
A2026		Restrata minimatrix, 5 mg	By Report
A4271		Home lancing/test cartridges	Section 9789.60 establishes payment conditions
A4438		Adhesive clip ext ens contr	Section 9789.60 establishes payment conditions
A4564		Pessary, disposable any type	By Report
A4593		Neuromod sti sys adj rehab	By Report
A4594		Neuromod adj rehab mouthpie	By Report
A9293		Fertility cycl tracking soft	By Report
A9506		Tc-99m graphite crucible	By Report
G0519		New pt-cg dyad dem low cmplx	By Report
G0520		New pt-cg dyad dem mod cmplx	By Report
G0521		New pt-cg dyad dem hig cmplx	By Report
G0522		Mgt nw pt dementia low cmplx	By Report
G0523		Mgt nw pt dem mod-high cmplx	By Report
G0524		Est pt-cg dyad dem low cmplx	By Report
G0525		Est pt-cg dyad dem mod cmplx	By Report
G0526		Est pt-cg dyad dem hig cmplx	By Report
G0527		Mgt est pt dmentia low cmplx	By Report
G0528		Mgt est pt dem mod-hi cmplx	By Report
G0529		In home respite care, 4 hr u	By Report
G0530		Adult daycare center, 8 hr u	By Report
G0531		Fclty-based respite, 24 hr u	By Report
G9037		Intrpro req fr rec phys/qhcp	RVU+GPCI+CF
G9038		Co-management services	RVU+GPCI+CF
H0051		Traditional healing service	By Report
J0211		Inj, nithiodote, 3mg / 125mg	By Report
J0687		Inj cefazolin (wg crit care)	By Report
J0872		Daptomycin (xellia) unrefrig	By Report
J0911		Inst tauro 1.35mg/hep 100u	By Report
J1597		Inj glycopyrrolate, glyrx-pf	By Report
J1598		Inj glycopyrrolate fres kabi	By Report
J1748		Inj, zymfentra, 10 mg	By Report
J2183		Inj meropenem (wg crit care)	By Report
J2246		Inj, micafungin (baxter)	By Report
J2267		Inj, mirikizumab-mrkz, 1 mg	By Report
J2373		Inj, immphentiv, 20 mcg	By Report
J2468		Inj, palonosetron (avyxa)	By Report
J2470		Inj pantoprazole sodium 40mg	By Report
J2471		Inj pantoprazole(hikma) 40mg	By Report
J3247		Inj secukinumab intrav 1mg	By Report
J3263		Inj, toripalimab-tpzi, 1 mg	By Report
J3393		Inj, betibeglogene autotemce	By Report
J3394		Inj, lovotibeglogene autotem	By Report
J7171		Inj, adzynma, 10 iu	By Report
J7355		Inj travoprost intra impl	By Report
J8611		Oral methotrexate (jylamvo)	By Report
J8612		Oral methotrexate (xatmep)	By Report
J9361		Inj, efbemalenograstim alfa-	By Report
M0224		Pemivibart infusion	By Report
Q0224		Inj, pemivibart, 4500 mg	By Report
Q4311		Acesso, per sq cm	By Report
Q4312		Acesso ac, per sq cm	By Report
Q4313		Dermabind fm, per sq cm	By Report
Q4314		Reeva, per sq cm	By Report
Q4315		Regenelink amniotic mem allo	By Report
Q4316		Amchoplast, per sq cm	By Report
Q4317		Vitograft, per sq cm	By Report
Q4318		E-graft, per sq cm	By Report
Q4319		Sanograft, per sq cm	By Report
Q4320		Pellograft, per sq cm	By Report
Q4321		Renograft, per sq cm	By Report
Q4322		Caregraft, per sq cm	By Report
Q4323		Alloply, per sq cm	By Report
Q4324		Amniotx, per sq cm	By Report
Q4325		Acapatch, per sq cm	By Report
Q4326		Woundplus, per sq cm	By Report
Q4327		Duoamnion, per sq cm	By Report
Q4328		Most, per sq cm	By Report
Q4329		Singlay, per sq cm	By Report
Q4330		Total, per sq cm	By Report
Q4331		Axolotl graft, per sq cm	By Report
Q4332		Axolotl dualgraft, per sq cm	By Report
Q4333		Ardeograft, per sq cm	By Report
Q5137		Inj, wezlana, sub cu, 1 mg	By Report
Q5138		Inj, wezlana, iv, 1 mg	By Report
S4988		Penile contractur devic manu	By Report
S9002		Intra-vag motion sens biofk	By Report

Again, bills submitted via daisyBill will automatically reflect the most current, accurate reimbursement rates. If you have any questions regarding this fee schedule update, use the chat function at the bottom right of this screen or email our experts at info@daisybill.com.

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