CA OMFS: 2025 'WC' Report Billing Codes

CA OMFS: 2025 'WC' Report Billing Codes

California’s Division of Workers’ Compensation (CA DWC) recently announced updates to the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS), effective for dates of services rendered on or after February 1, 2025.

These updates include increases for California-specific billing codes for reports and other documentation (prefixed with “WC”).

The DWC OMFS website lists the most recent orders and related documents. Below is a complete list of the new reimbursements for “WC” codes effective for dates of service on or after February 1, 2025.

The daisyWizard Fee Calculator and daisyBill software have already been updated with these new WC code reimbursement values.

California-Specific Codes: Reimbursement Increase

California Code of Regulations Section 9789.12.14 establishes “California Specific Codes,” which begin with the prefix “WC.” Physicians report these codes when submitting reports or furnishing copies of chart notes, x-rays, or scans.

For example, a primary treating physician should bill WC002 when submitting the required PR-2 progress report. Beginning February 1, the reimbursement for WC002 will be $15.72—up 3.49% from the current rate.

The CA DWC establishes new reimbursements for these WC codes annually. The table below outlines the latest reimbursement rates due as of February 1st and the percentage change in reimbursement.

California-Specific Billing Code

Description

Reimbursement Effective 2/1/2025

Additional Page Reimbursement Effective 2/1/2025

2025 Reimbursement Change %

WC001

Doctor’s First Report of Occupational Illness or Injury (Form 5021)

Not reimbursable

N/A (not applicable)

N/A

WC002

Primary Treating Physician’s Progress Report (Form PR-2)

$15.72

n/a

3.49%

WC003

Primary Treating Physician’s Permanent & Stationary Report (Form PR-3)

$48.69 for first page

$29.93 each additional page. Maximum of six pages absent mutual agreement ($198.34)

3.51%

WC004

Primary Treating Physician’s Permanent & Stationary Report (Form PR-4)

$48.69 for first page

$29.93 each additional page. Maximum of seven pages absent mutual agreement ($228.27)

3.51%

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report

$48.69 for first page

$29.93 each additional page. Maximum of six pages absent mutual agreement ($198.34)

3.51%

WC007

Consultation Reports requested by the WCAB or the Administrative Director

$48.69 for first page

$29.93 each additional page. Maximum of six pages absent mutual agreement ($198.34)

3.51%

WC008

Chart Notes

$14.07 for up to the first 15 pages

$0.29 for each additional page after the first 15 pages

3.53%

WC009

Duplicate Reports

$14.07 for up to the first 15 pages

$0.29 for each additional page after the first 15 pages

3.53%

WC010

Duplication of X-Ray

$6.45 per x-ray

N/A

3.53%

WC011

Duplication of Scan

$14.07 per scan

N/A

3.53%

WC012

Missed Appointments. This code is designated for communication only. It does not imply that compensation is owed. Non-reimbursable absent agreement.

No Fee Prescribed/Non Reimbursable absent agreement

N/A

N/A

Stay tuned—we’ll report on additional changes to the Physician Fee Schedule in this space.


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