CA OMFS Update: Physician Services (Q4 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 October 1, 2023.
The update adds 36 new procedure codes, all reimbursable “By Report.”
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!
36 New HCPCS Codes
The new Healthcare Common Procedure Coding System (HCPCS) codes adopted by the DWC (and CMS) for Q4 2023 are listed below.
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; providers find a comparable procedure regarding time, skill, and resources required and charge accordingly.
The provider must submit a Request For Authorization (RFA) for the BR code, including the reimbursement amount, and justify the amount charged with a separate (non-reimbursable) report.
Q4 2023 New HCPCS Codes for CA Workers’ Comp Physician Services
HCPCS |
Description |
Reimbursement |
A2022 |
Innovabrn/innovamatx xl sqcm |
By Report |
A2023 |
Innovamatrix pd, 1 mg |
By Report |
A2024 |
Resolve matrix per sq cm |
By Report |
A2025 |
Miro3d per cubic cm |
By Report |
A9156 |
Oral mucoadhesive per 1 ml |
By Report |
A9268 |
Programmer orally ingest cap |
By Report |
A9269 |
Programable ingest capsule |
By Report |
A9292 |
Pres dig visual therapy fda |
By Report |
A9573 |
Inj, gadopiclenol, 1 ml |
By Report |
A9603 |
Inj, pafolacianine, 0.1 mg |
By Report |
A9697 |
Inj, magtrace per study dose |
By Report |
H2040 |
Coord specialty care, month |
By Report |
H2041 |
Coord special care encounter |
By Report |
J0174 |
Injection, lecanemab-irmb, 1 |
By Report |
J0349 |
Inj, rezafungin, 1 mg |
By Report |
J0801 |
Inj. acthar gel to 40 units |
By Report |
J0802 |
Inj. (ani), up to 40 units |
By Report |
J0874 |
Inj, daptomycin (baxter) |
By Report |
J0889 |
Daprodustat oral 1mg esrd |
By Report |
J2359 |
Inj. olanzapine, 0.5mg |
By Report |
J2781 |
Inj, pegcetacoplan, 1mg |
By Report |
J7214 |
Altuviiio per factor viii iu |
By Report |
J7353 |
Anacaulase-bcdb 8.8% gel 1 g |
By Report |
J7519 |
Inj. mycophenolate mofetil |
By Report |
J9051 |
Inj, bortezomib (maia) |
By Report |
J9064 |
Inj, cabazitaxel (sandoz) |
By Report |
J9345 |
Inj, retifanlimab-dlwr, 1 mg |
By Report |
Q4285 |
Nudyn dl or dl mesh pr sq cm |
By Report |
Q4286 |
Nudyn sl or slw, per sq cm |
By Report |
V2526 |
Cntct lens blue violet |
By Report |
0121A |
Adm sarscv2 bvl 30mcg/.3ml 1 |
By Report |
0141A |
Adm srscv2 bvl 25mcg/.25ml 1 |
By Report |
0142A |
Adm srscv2 bvl 25mcg/.25ml 2 |
By Report |
0151A |
Adm sarscv2 bvl 10mcg/.2ml 1 |
By Report |
0171A |
Adm sarscv2 bvl 3mcg/0.2ml 1 |
By Report |
0172A |
Adm sarscv2 bvl 3mcg/0.2ml 2 |
By Report |
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