Despite controversial cuts to reimbursement rates for Medicare, California’s Division of Workers’ Compensation (DWC) has not announced changes to reimbursement rates for Physician and Non-Physician Practitioner services under the Official Medical Fee Schedule (OMFS).

As of this writing, 2023 California Physician Fee Schedule rates remain unchanged from Q4 2022.

Read on for a brief explanation of the relationship between Medicare and the OMFS. As always, daisyBill and daisyWizard will be updated to reflect any future changes to the OMFS, and any substantive changes to the Physician Fee Schedule will be reported in this space.

CA OMFS & Medicare

California Labor Code Section 5307.1 specifically requires the DWC to maintain an alignment between the OMFS and Medicare.

After much political wrangling, planned 2023 cuts to Medicare reimbursement rates for Physician Services were decreased significantly. However, provider and patient advocates still decry any cuts as detrimental to the financial health of practices struggling to keep pace with record inflation and rising overall costs.

For the (increasingly few) California providers who choose to treat injured workers, the effects of decreases in Medicare reimbursement rates are amplified. Payer non-compliance with regulations, unenforced appeal rulings, friction induced by Medical Provider Networks (MPNs), and steep reimbursement cuts by voracious Preferred Provider Organizations (PPOs) are among the threats to provider revenue.

How and when cuts to Medicare physician reimbursement rates will reflect in the California OMFS remains to be seen. daisyBill will keep readers informed as information becomes available.

Know (and get) exactly what you’re owed for treating injured workers. Get instant, accurate fee schedule calculations with daisyWizard’s OMFS Calculator.

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