California’s Division of Workers’ Compensation (CA DWC) updated the Pathology and Clinical Laboratory portion of the Official Medical Fee Schedule (OMFS), effective for services rendered on or after January 1, 2026.

The CA DWC announced the order in a December 29th, 2025 Newsline. The update makes several significant changes to the Pathology/Clinical Laboratory fee schedule, including:

• Adding 23 new Pathology codes
• Deleting 10 Pathology codes

The update aligns the OMFS with the most recent changes to Medicare as required by California Labor Code Section 5307.1.

As always, daisyBill has updated our billing software and Fee Schedule Calculator with the latest reimbursements.

Pathology, Clinical Laboratory Fee Schedule Changes

The CA DWC update adopts the Center for Medicare and Medicaid (CMS)’s 2026 annual Pathology and Clinical Laboratory update. This includes fee schedule changes identified in the December 5, 2025 “CMS Transmittal 13514, Change Request CR 14312.”

The California workers’ comp Pathology/Clinical Laboratory fee schedule reimbursement rates remain at 120% of the Medicare reimbursement rates for the same services, specifically those set forth in the calendar year 2026 Quarter One Medicare Clinical Laboratory Fee Schedule, contained in the file “26CLABQ1.”

New Pathology and Clinical Laboratory Procedure Codes

Below we list the 23 Healthcare Common Procedure Coding System (HCPCS) codes (and modifiers, where applicable) the update adds to the Pathology and Clinical Laboratory fee schedule for California workers’ comp.

Deleted Pathology and Clinical Laboratory Procedure Codes

The update also deletes ten HCPCS codes, as shown below.

daisyBillers, rest easy. All Pathology and Clinical Laboratory fee schedule changes are reflected in daisyBill billing software and the daisyWizard Fee Schedule Calculator.

Again, the changes listed here are effective for all dates of service on or after January 1st.

For any questions regarding fee schedules, contact us using the chat icon in the bottom right corner of this screen, or email us at info@daisybill.com.

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