2025 CA Physician Fee Schedule Changes

January 23, 2025 16 min read

By: the daisyNews Team

California’s Division of Workers’ Compensation (CA 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 February 1, 2025.

The update aligns the OMFS to relevant Medicare payment system changes, as California Labor Code Section 5307.1 requires.

The CA DWC announced the update in a Newsline and posted the adoption order on its website. Read on for details.

The 2025 Physician Fee Schedule update includes five substantive changes:

An increase in the Conversion Factor for calculating Physician Fee Schedule reimbursement rates
Higher reimbursements for California-Specific Codes
New reimbursement calculations for 16 procedure codes
318 new procedure codes
128 deleted procedure codes

CA DWC Increases Conversion Factor

Calculating reimbursement rates for physician services first requires determining the “Base Maximum Fee” before applying other fee-affecting modifiers or rules.

Under the current fee schedule, based on the Centers for Medicare and Medicaid Services (CMS) Resource-Based Relative Value Scale (RBRVS), calculating the Base Maximum Fee involves three factors:

Relative Value Units (RVUs) as determined by Medicare
Geographic Practice Cost Index (GPCI) as determined by Medicare
Conversion Factor (CF) as determined by the CA DWC

The Conversion Factor for calculating OMFS reimbursements for physician services is increasing from $48.51 to $48.79. With the increased conversion factor, the OMFS will pay 150.84% of Medicare rates for the same services.

With this Conversion Factor increase, the CA DWC acknowledges that treating injured workers requires about 50% more work than treating a Medicare patient—though California still allows PPOs to drastically reduce reimbursement rates to well below OMFS (and sometimes even below Medicare) rates.

HCPCS: CA DWC Alters Reimbursement Calculations for 16 Codes

Besides the above Conversion Factor change, the reimbursement calculation changed for 16 existing procedure codes.

Of note, four codes formerly billable only “By Report” now have established reimbursement amounts as detailed in the table below: 96547, 96548, G0138, and G0465 (74263 previously had an established reimbursement amount; only its Status Code changed, which is not fee-affecting).

HCPCS	Modifier	Description	Reimbursement Calculation
74263	26	Ct colonography screening	RVU+GPCI+CF
74263	TC	Ct colonography screening	RVU+GPCI+CF
74263		Ct colonography screening	RVU+GPCI+CF
90658		Iiv3 vaccine splt 0.5 ml im	By Report
96547		Intraop hipec px 1st 60 min	RVU+GPCI+CF
96548		Ntraop hipec px ea add 30min	RVU+GPCI+CF
0528F		Rcmnd flw-up 10 yrs docd	By Report
3044F		Hg a1c level lt 7.0%	By Report
3051F		Hg a1c>equal 7.0%<8.0%	By Report
3052F		Hg a1c>equal 8.0%<equal 9.0%	By Report
3570F		Rprt bone scint xref w xray	By Report
4131F		Syst antimicrobial thx rx	By Report
4132F		No syst antimicrobial thx rx	By Report
5050F		Plan 2 main dr by 1 month	By Report
G0138		Iv cipaglucosidase alfa-atga	RVU+GPCI+CF
G0465		Autolog prp diab wound ulcer	RVU+GPCI+CF

HCPCS: 318 New Codes & 128 Deleted Codes

Below are the new Healthcare Common Procedure Coding System (HCPCS) codes the CA DWC (and CMS) adopted for 2025, and the HCPCS the CA DWC deleted from the California Physician Fee Schedule.

For reimbursement calculations, when Medicare fails to assign an HCPCS code a Relative Value Unit (RVU), the OMFS dictates that the reimbursement is calculated “By Report” (BR).

California Code of Regulations Section 9789.12.4 offers guidelines for determining appropriate reimbursement amounts for BR codes. This regulation instructs providers to find a comparable procedure regarding time, skill, and resources required and to charge accordingly. The provider must justify the amount charged for these HCPCS with a separate (non-reimbursable) report.

CA DWC Adds 318 New HCPCS to Physician Services Fee Schedule

HCPCS	Modifier	Description	Reimbursement Calculation
15011		Hrv skn cll ssp agrft 1st 25	By Report
15012		Hrv skn cll ssp agrft ea add	By Report
15013		Prepj skn cll ssp agrft 1st	By Report
15014		Prepj skn cll ssp agrft ea	By Report
15015		App skn cl ssp agrft t/a/l 1	By Report
15016		App skn cl ssp agrf t/a/l ea	By Report
15017		App skn cll ssp f/n/g/hf 1st	By Report
15018		App skn cll ssp f/n/g/hf ea	By Report
25448		Arthrp ntrcrpl/crp/mtcrp ssp	RVU+GPCI+CF
38225		Car-t hrv bld-drv t lymphcyt	No payment amount
38226		Car-t prep t lymphcyt f/trns	No payment amount
38227		Car-t receipt&prepj admn	No payment amount
38228		Car-t admn autologous	RVU+GPCI+CF
49186		Opn exc/dstr ntra-abd 5 cm/<	RVU+GPCI+CF
49187		Opn exc/dstr ntra-abd 5.1-10	RVU+GPCI+CF
49188		Opn exc/dst ntra-abd 10.1-20	RVU+GPCI+CF
49189		Opn exc/dst ntra-abd 20.1-30	RVU+GPCI+CF
49190		Opn exc/dstr ntra-abd >30 cm	RVU+GPCI+CF
51721		Ins trurl ablt trnsdc thr us	RVU+GPCI+CF
53865		Cysto insj dev ischmc rmdlg	RVU+GPCI+CF
53866		Cathj rmvl dev ischmc rmdlg	RVU+GPCI+CF
55881		Ablt trurl prst8 tis thrm us	RVU+GPCI+CF
55882		Ablt trurl prst8 tis trnsdcr	RVU+GPCI+CF
60660		Abltj 1/+thyr ndul 1lobe prq	RVU+GPCI+CF
60661		Abltj 1/+thyr ndul addl prq	RVU+GPCI+CF
61715		Mrgfus strtctc ablt trgt icr	RVU+GPCI+CF
64466		Thrc fascial pln blk uni njx	RVU+GPCI+CF
64467		Thrc fascial pln blk uni nfs	RVU+GPCI+CF
64468		Thrc fascial pln blk bi njx	RVU+GPCI+CF
64469		Thrc fascial pln blk bi nfs	RVU+GPCI+CF
64473		Lwr xtr fscl pln blk uni njx	RVU+GPCI+CF
64474		Lwr xtr fscl pln blk uni nfs	RVU+GPCI+CF
66683		Implantation iris prosthesis	RVU+GPCI+CF
76014		Mr sfty implt&/fb asmt stf 1	RVU+GPCI+CF
76015		Mr sfty mplt&/fb asmt stf ea	RVU+GPCI+CF
76016	TC	Mr safety deter phys/qhp	RVU+GPCI+CF
76016	26	Mr safety deter phys/qhp	RVU+GPCI+CF
76016		Mr safety deter phys/qhp	RVU+GPCI+CF
76017		Mr sfty med physics xm cstmz	RVU+GPCI+CF
76017	26	Mr sfty med physics xm cstmz	RVU+GPCI+CF
76017	TC	Mr sfty med physics xm cstmz	RVU+GPCI+CF
76018	26	Mr safety implant elec prepj	RVU+GPCI+CF
76018	TC	Mr safety implant elec prepj	RVU+GPCI+CF
76018		Mr safety implant elec prepj	RVU+GPCI+CF
76019	TC	Mr safety implt pos&/immoblj	RVU+GPCI+CF
76019	26	Mr safety implt pos&/immoblj	RVU+GPCI+CF
76019		Mr safety implt pos&/immoblj	RVU+GPCI+CF
81195		Cytog genom-wid alys hem mal	By Report
81515		Nfct ds bv&vaginitis dna alg	By Report
81558		Trnspl rej kdn mrna qpcr 139	By Report
82233		Beta-amyloid 1-40 (abeta 40)	By Report
82234		Beta-amyloid 1-42 (abeta 42)	By Report
83884		Assay neurflmnt light chain	By Report
84393		Tau phosphorylated ea	By Report
84394		Total tau	By Report
86581		Strptcs pneum antb serot ia	By Report
87513		H pylri clrthmcn rst amp prb	By Report
87564		Mtb rifampin rst amp prb tq	By Report
87594		Pneumcysts jirovecii amp prb	By Report
87626		Hpv sep hi-rsk typ&pool rslt	By Report
90593		Chikungunya vacc recomb im	By Report
92137	26	Cptrz oph img pst sg rta oct	RVU+GPCI+CF
92137	TC	Cptrz oph img pst sg rta oct	RVU+GPCI+CF
92137		Cptrz oph img pst sg rta oct	RVU+GPCI+CF
93896	TC	Vsrctv std tcd icr art compl	RVU+GPCI+CF
93896	26	Vsrctv std tcd icr art compl	RVU+GPCI+CF
93896		Vsrctv std tcd icr art compl	RVU+GPCI+CF
93897		Emboli detcj wo iv mbubb njx	RVU+GPCI+CF
93897	TC	Emboli detcj wo iv mbubb njx	RVU+GPCI+CF
93897	26	Emboli detcj wo iv mbubb njx	RVU+GPCI+CF
93898	TC	Ven-artl shunt det mbubb njx	RVU+GPCI+CF
93898		Ven-artl shunt det mbubb njx	RVU+GPCI+CF
93898	26	Ven-artl shunt det mbubb njx	RVU+GPCI+CF
96041		Genetic counseling svc ea 30	No payment amount
98000		Synch audio-video new sf 15	RVU+GPCI+CF
98001		Synch audio-video new low 30	RVU+GPCI+CF
98002		Synch audio-video new mod 45	RVU+GPCI+CF
98003		Synch audio-video new hi 60	RVU+GPCI+CF
98004		Synch audio-video est sf 10	RVU+GPCI+CF
98005		Synch audio-video est low 20	RVU+GPCI+CF
98006		Synch audio-video est mod 30	RVU+GPCI+CF
98007		Synch audio-video est hi 40	RVU+GPCI+CF
98008		Synch audio-only new sf 15	RVU+GPCI+CF
98009		Synch audio-only new low 30	RVU+GPCI+CF
98010		Synch audio-only new mod 45	RVU+GPCI+CF
98011		Synch audio-only new high 60	RVU+GPCI+CF
98012		Synch audio-only est sf 10	RVU+GPCI+CF
98013		Synch audio-only est low 20	RVU+GPCI+CF
98014		Synch audio-only est mod 30	RVU+GPCI+CF
98015		Synch audio-only est high 40	RVU+GPCI+CF
98016		Brief comunicaj tech-bsd svc	RVU+GPCI+CF
0417T	TC	Prgrmg eval cardiac modulj	By Report
0417T	26	Prgrmg eval cardiac modulj	By Report
0418T	TC	Interro eval cardiac modulj	By Report
0418T	26	Interro eval cardiac modulj	By Report
0901T		Plmt bone marrow smplg port	By Report
0902T		Qtc ntrvl augmnt alg aly ecg	By Report
0903T		Ecg alg 12 lead reduced i&r	By Report
0904T		Ecg alg 12 ld rdcd trcg only	By Report
0905T		Ecg alg 12 ld rdcd i&r only	By Report
0906T		Coms ther 1st appl<=50 sq cm	By Report
0907T		Coms ther ea addl<=50 sq cm	By Report
0908T		Opn imp int nstm sys vgs nrv	By Report
0909T		Rplcmt int nstim sys vgs nrv	By Report
0910T		Rmvl int nstim sys vagus nrv	By Report
0911T		Elec aly nstm sys vgs nrv wo	By Report
0912T		Elec alys nstim sys vgs smpl	By Report
0913T		Prq tcat ther rx ntrac balo1	By Report
0914T		Prq tcat thr rx ntrc bal sep	By Report
0915T		Insj perm ccm-d sys pg&eltrd	By Report
0916T		Insj perm ccm-d sys pg only	By Report
0917T		Insj perm ccm-d sys 1 lead	By Report
0918T		Insj perm ccm-d sys dual ld	By Report
0919T		Rmvl perm ccm-d sys pg only	By Report
0920T		Rmvl perm ccm-d sys 1 pac ld	By Report
0921T		Rmvl perm ccm-d sys 1 dfb ld	By Report
0922T		Rmvl perm ccm-d sys dual ld	By Report
0923T		Rmvl&rplcmt perm ccm-d pg	By Report
0924T		Rpos prv ccm-d trnsvns eltrd	By Report
0925T		Rlcj skin pocket ccm-d pg	By Report
0926T	26	Prgrmg dev eval ccm-d ip	By Report
0926T		Prgrmg dev eval ccm-d ip	By Report
0926T	TC	Prgrmg dev eval ccm-d ip	By Report
0927T	26	Interrog dev eval ccm-d ip	By Report
0927T		Interrog dev eval ccm-d ip	By Report
0927T	TC	Interrog dev eval ccm-d ip	By Report
0928T		Rem interrog dev ccm-d phys	By Report
0929T		Rem interrog dev ccm-d tech	By Report
0930T		Ephys eval ccm-d ld 1st impl	By Report
0930T	26	Ephys eval ccm-d ld 1st impl	By Report
0930T	TC	Ephys eval ccm-d ld 1st impl	By Report
0931T	TC	Ephys eval ccm-d ld separate	By Report
0931T		Ephys eval ccm-d ld separate	By Report
0931T	26	Ephys eval ccm-d ld separate	By Report
0932T	TC	N-invs det hrt fail aug echo	By Report
0932T		N-invs det hrt fail aug echo	By Report
0932T	26	N-invs det hrt fail aug echo	By Report
0933T		Tcat impl wrls l atr prs snr	By Report
0934T		Rem mntr wrls l atr prs snr	By Report
0935T		Cysto w/rnl pel symp dnrvtj	By Report
0936T		Photobiomodulation ther rta	By Report
0937T		Xtrnl ecg rec>15d<30d	By Report
0938T		Xtrnl ecg rec>15d<30d rec	By Report
0939T		Xtrnl ecg rec>15d<30d scan	By Report
0940T		Xtrnl ecg rec>15d<30d r&i	By Report
0941T		Cysto flx ins&xpns urtl scaf	By Report
0942T		Cysto flx rmv&rplc urtl scaf	By Report
0943T		Cysto flx rmvl urtl scaffold	By Report
0944T	TC	3d cntr simula trgt lvr les	By Report
0944T	26	3d cntr simula trgt lvr les	By Report
0944T		3d cntr simula trgt lvr les	By Report
0945T		Intraop assmt abnl tum tiss	By Report
0946T		Ortho impl mvmt alys pair ct	By Report
0946T	TC	Ortho impl mvmt alys pair ct	By Report
0946T	26	Ortho impl mvmt alys pair ct	By Report
0947T		Mrgfus strtctc bl-br disrpj	By Report
0947T	26	Mrgfus strtctc bl-br disrpj	By Report
0947T	TC	Mrgfus strtctc bl-br disrpj	By Report
A2027		Matriderm per sq cm	By Report
A2028		Micromatrix flex per mg	By Report
A2029		Mirotract matrix sheet	By Report
A4543		Supply trans elec nerve stim	By Report
A4544		Electro nerve stimulator rls	Section 9789.60 establishes payment conditions
A4545		Suppl accessor tibial stim	Section 9789.60 establishes payment conditions
A7021		Suppl and access lung expan	Section 9789.60 establishes payment conditions
A9615		Inj, pegulicianine, 1 mg	By Report
D2956		Indirect rest remov	By Report
D6180		Implnt maint proced	By Report
D6193		Replace implnt screw	By Report
D7252		Part extract for implant	By Report
D7259		Nerve dissection	By Report
D8091		Compre ortho treat w surg	By Report
D8671		Periodic orth treat w surg	By Report
D9913		Admin of neuromod	By Report
D9914		Admin of dermal fill	By Report
D9959		Unspec sleep ap proc	By Report
G0532		Take home supp nasal spray	By Report
G0533		Buprenorphone inj weekly	By Report
G0534		Coordinated care/or referral	By Report
G0535		Pt navigat svs direct/ref	By Report
G0536		Peer recover support svs	By Report
G0537		Risk ascvd tst once pr 12 mo	RVU+GPCI+CF
G0538		Ascvd rsk mng clin stf pr mo	RVU+GPCI+CF
G0539		Initial care training 30 m	RVU+GPCI+CF
G0540		Train for caregiver add 15	RVU+GPCI+CF
G0541		No pt prsnt train initial 30	RVU+GPCI+CF
G0542		No pt prsnt train add 15	RVU+GPCI+CF
G0543		Group train w/o patient	RVU+GPCI+CF
G0544		Post d/c phone follow up	RVU+GPCI+CF
G0545		Inherent visit to inpt	RVU+GPCI+CF
G0546		Phone/internet ehr assess	RVU+GPCI+CF
G0547		Phone/internet svs 11-20 m	RVU+GPCI+CF
G0548		Phone/inter svs 21-30 m	RVU+GPCI+CF
G0549		Phone/inter for treat>31m	RVU+GPCI+CF
G0550		Phone/inter for dx/treat >5m	RVU+GPCI+CF
G0551		Phn/intr svs fr dx treat 30m	RVU+GPCI+CF
G0552		Supply of digital device	By Report
G0553		Monthly tx for dmht 20mins	RVU+GPCI+CF
G0554		Add 20 m of monthly tx	RVU+GPCI+CF
G0555		Replacment pt electronic sys	By Report
G0556		Adv prim care mgmt lvl 1	RVU+GPCI+CF
G0557		Adv prim care mgmt lvl 2	RVU+GPCI+CF
G0558		Adv prim care mgmt lvl 3	RVU+GPCI+CF
G0559		Unrelat prac follow up visit	RVU+GPCI+CF
G0560		Safety plan interven	RVU+GPCI+CF
G0561		Temp tube delivery, unil	By Report
G0562	26	Complex simulation w/pet-ct	By Report
G0562		Complex simulation w/pet-ct	By Report
G0562	TC	Complex simulation w/pet-ct	By Report
G0563		Sbrt w/positron emission del	By Report
G0564		365 d implant glucose sensor	By Report
G0565		Rem/ins glu snsr 365 dif sit	By Report
H0052		Mmip mental health and care	By Report
H0053		Ht mental health and care	By Report
J0139		Inj, adalimumab, 1 mg	By Report
J0601		Sevelamer carbonate 20 mg	By Report
J0602		Sevelamer carbonate pdr 20mg	By Report
J0603		Sevelamer hydrochloride 20mg	By Report
J0605		Sucroferric oxyhydroxide 5mg	By Report
J0607		Lanthanum carbonate oral 5mg	By Report
J0608		Lanthanum carbonate pwdr 5mg	By Report
J0609		Ferric citrate orl 3 mg iron	By Report
J0615		Calcium acetate, oral, 23 mg	By Report
J0666		Inj, bupivacaine liposome	By Report
J0870		Injection, imetelstat, 1 mg	By Report
J0901		Vadadustat oral 1mg for esrd	By Report
J1307		Inj, crovalimab-akkz, 10 mg	By Report
J1414		Inj, beqvez, per tx dose	By Report
J1552		Inj, alyglo, 500 mg	By Report
J2290		Inj, nafcillin sodium, 20 mg	By Report
J2472		Inj, pantoprazole sodium chl	By Report
J2802		Inj, romiplostim 1 microgram	By Report
J3392		Inj, exagamglogene autotem	By Report
J7514		Mycophenol (myhibbin) 100 mg	By Report
J7601		Ensifentrine inh 3 mg	By Report
J9026		Inj, tarlatamab-dlle, 1 mg	By Report
J9028		Inj, nogapendekin pmln, 1mcg	By Report
J9076		Inj, cyclophos (baxter) 5mg	By Report
J9292		Inj, pemetrexed (avyxa) 10mg	By Report
M1371		Mst rec gsa<7	Reporting purposes only
M1372		Mst rec gsa >=7 and<8	Reporting purposes only
M1373		Mst rec gsa >=8 and <=9	Reporting purposes only
M1374		Ra dx enc 90 days dur per pd	Reporting purposes only
M1375		Ra dx enc 90 days dur per pd	Reporting purposes only
M1376		Ra dx enc 90 days dur per pd	Reporting purposes only
M1377		Fu colscop 10 yr doc w/ disc	Reporting purposes only
M1378		Med rsn no 10 yr fu colscope	Reporting purposes only
M1379		10 yr fu no rec rsn not giv	Reporting purposes only
M1380		2 rx in perf pd any com meds	Reporting purposes only
M1381		Pt sec strk wthin 5 days	Reporting purposes only
M1382		Enc dur perf pd pos 11	Reporting purposes only
M1383		Acute pvd	Reporting purposes only
M1384		Pt died dur perf pd	Reporting purposes only
M1385		Pt rsn not seen 2nd pam	Reporting purposes only
M1386		Exc sx melmn or mlnm is	Reporting purposes only
M1387		Pt died dur perf pd	Reporting purposes only
M1388		Pt doc exm rec melmn	Reporting purposes only
M1389		Pt rsn no exm	Reporting purposes only
M1390		Pt no doc exm for rec	Reporting purposes only
M1391		All pt dx w/ rec mlnm	Reporting purposes only
M1392		Pt rsn no exm or lst to fu	Reporting purposes only
M1393		Pr no dx rec mlnm	Reporting purposes only
M1394		Stg i-iii br ca	Reporting purposes only
M1395		Init chemo w/def dur ec grp	Reporting purposes only
M1396		Pt ther clin trial	Reporting purposes only
M1397		Pt w/ recur/prog	Reporting purposes only
M1398		Bslne and fu promis doc	Reporting purposes only
M1399		Pt lve prac	Reporting purposes only
M1400		Pt died dur perf pd	Reporting purposes only
M1401		Stg i-iii br ca	Reporting purposes only
M1402		Init chemo w/def dur ec grp	Reporting purposes only
M1403		Bslne and fu promis doc	Reporting purposes only
M1404		Pt ther clin trial	Reporting purposes only
M1405		Pt w/ recur/prog	Reporting purposes only
M1406		Pt lve prac	Reporting purposes only
M1407		Pt died dur perf pd	Reporting purposes only
M1408		Gmln brca bef dx ca	Reporting purposes only
M1409		Recd gmln brca1/brca2 couns	Reporting purposes only
M1410		No gmln brca1/brca2 couns	Reporting purposes only
M1411		1st ln ici no chemo	Reporting purposes only
M1412		Met nsclc w/ egfr alk oth ab	Reporting purposes only
M1413		Pos pdl1 bef init ici tx	Reporting purposes only
M1414		Med rsn no pdl1 bef 1st ther	Reporting purposes only
M1415		No pos pdl1 bef ici ther	Reporting purposes only
M1416		Pt rec hosp	Reporting purposes only
M1417		Pt up to date cov	Reporting purposes only
M1418		Med rsn not up to date cov	Reporting purposes only
M1419		Pt not up to date cov	Reporting purposes only
M1420		Complete ophthalmologic mvp	Reporting purposes only
M1421		Dermatological care mvp	Reporting purposes only
M1422		Gastroenterology care mvp	Reporting purposes only
M1423		Opt care urologic cnd mvp	Reporting purposes only
M1424		Pulmonology care mvp	Reporting purposes only
M1425		Surgical care mvp	Reporting purposes only
P9027		Rbc o2 co2 reduced	By Report
Q0155		Dronabinol (syndros) 0.1 mg	By Report
Q0521		Supply fee hiv prep fda appr	By Report
Q4346		Shelter dm matrix per sq cm	By Report
Q4347		Rampart dl matrix per sq cm	By Report
Q4348		Sentry sl matrix per sq cm	By Report
Q4349		Mantle dl matrix per sq cm	By Report
Q4350		Palisade dm matrix per sq cm	By Report
Q4351		Enclose tl matrix, per sq cm	By Report
Q4352		Overlay sl matrix, per sq cm	By Report
Q4353		Xceed tl matrix per sq cm	By Report
Q5139		Inj, eculizumab-aeeb, 10 mg	By Report
Q5140		Inj adalimumab-fkjp, 1 mg	By Report
Q5141		Inj adalimumab-aaty, 1 mg	By Report
Q5142		Inj adalimumab-ryvk, 1 mg	By Report
Q5143		Inj adalimumab-adbm, 1 mg	By Report
Q5144		Inj, idacio, 1 mg	By Report
Q5145		Inj, abrilada, 1 mg	By Report
Q5146		Inj, hercessi, 10 mg	By Report
Q9996		Ustekinumab- ttwe sub cu inj	By Report
Q9997		Ustekinumab-ttwe iv inj 1 mg	By Report
Q9998		Ustekinumab-aekn inj	By Report
U0001		2019-ncov diagnostic p	Section 9789.50 establishes payment conditions
U0002		Covid-19 lab test non-cdc	Section 9789.50 establishes payment conditions

CA DWC Deletes 128 HCPCS From Physician Services Fee Schedule

The update to the Physician Fee Schedule deletes 128 procedure codes. As we list below, the CA OMFS no longer reimburses these codes.

HCPCS	Modifier	Description
15819		Plastic surgery neck
21632		Extensive sternum surgery
33471		Vlvt pv clsd hrt via p-art
33737		Revision of heart chamber
33813		Repair septal defect
47802		Fuse liver duct & intestine
49203		Exc abd tum 5 cm or less
49204		Exc abd tum over 5 cm
49205		Exc abd tum over 10 cm
50135		Pyelotomy complicated
51030		Incise & treat bladder
54438		Replantation of penis
58957		Resect recurrent gyn mal
81433		Hrdtry brst ca-rlatd dsordrs
81436		Hereditary colon ca dsordrs
81438		Heredtry nurondcrn tum dsrdr
86327	26	Immunoelectrophoresis assay
86327		Immunoelectrophoresis assay
86490		Coccidioidomycosis skin test
88388	TC	Tiss ex molecul study add-on
88388		Tiss ex molecul study add-on
88388	26	Tiss ex molecul study add-on
90630		Flu vacc iiv4 no preserv id
90654		Flu vacc iiv3 no preserv id
93890	TC	Tcd vasoreactivity study
93890	26	Tcd vasoreactivity study
93890		Tcd vasoreactivity study
96003		Dynamic fine wire emg
96040		Genetic counseling 30 min
99441		Phone e/m phys/qhp 5-10 min
99442		Phone e/m phys/qhp 11-20 min
99443		Phone e/m phys/qhp 21-30 min
0398T	TC	Mrgfus strtctc les abltj
0398T		Mrgfus strtctc les abltj
0398T	26	Mrgfus strtctc les abltj
0500T		Hpv 5+ hi risk hpv types
0537T		Bld drv t lymphcyt car-t cll
0538T		Bld drv t lymphcyt prep trns
0539T		Receipt&prep car-t cll admn
0540T		Car-t cll admn autologous
0553T		Perq tcat iliac anast implt
0564T		Onc chemo rx cytotox csc 14
0567T		Perm flp tube occls w/implt
0568T		Intro mix saline&air f/ssg
0616T		Insertion of iris prosthesis
0617T		Insj iris prosth w/rmvl&insj
0618T		Insj iris prosth sec io lens
D2941		Int therapeutic restoration
D6095		Odontics repr abutment
G0106		Colon ca screen;barium enema
G0106	26	Colon ca screen;barium enema
G0106	TC	Colon ca screen;barium enema
G0120	TC	Colon ca scrn; barium enema
G0120		Colon ca scrn; barium enema
G0120	26	Colon ca scrn; barium enema
G0122	TC	Colon ca scrn; barium enema
G0122		Colon ca scrn; barium enema
G0122	26	Colon ca scrn; barium enema
G2012		Brief check in by md/qhp
G2070		Med assist tx implant
G2071		Med tx remove implant
G2072		Med tx insert/remove imp
G8482		Flu immunize order/admin
G8483		Flu imm no admin doc rea
G8484		Flu immunize no admin
G8965		Csit perf on low chd rsk
G8966		Csit perf sx or high chd rsk
G9402		Recd f/u w/in 30d disch
G9403		Doc reas no 30 day f/u
G9404		No 30 day f/u
G9405		Recd f/u w/in 7d dc
G9406		Doc reas no 7d f/u
G9407		No 7d f/u
G9458		Tob user recd cess interv
G9459		Tob non-user
G9460		No tob assess or cess inter
G9707		Pt had hosp dur msmt per
G9751		Pt died w/in 24 mos rpt time
G9760		Pt w/hosp anytime msmt per
G9892		Doc pt rsn no dil mac exam
G9893		No mac exam
G9919		Scrn nd pos nd prov of rec
G9920		Scrning perf and negative
G9921		No or part scrn nd rng or os
G9974		Mac exam perf
G9975		Doc med rsn no dil mac exam
G9990		No pneum vax admin 19+
G9991		Pneum vax admin 19+
J0135		Adalimumab injection
J0570		Buprenorphine implant 74.2mg
J0576		Inj buprenorph (brixadi) 1mg
J1020		Methylprednisolone 20 mg inj
J1030		Methylprednisolone 40 mg inj
J1040		Methylprednisolone 80 mg inj
J1170		Hydromorphone injection
J1840		Kanamycin sulfate 500 mg inj
J1850		Kanamycin sulfate 75 mg inj
J2001		Lidocaine injection
J2780		Ranitidine hydrochloride inj
J2796		Romiplostim injection
J2806		Inj sincalide, maia, 5 mcg
J2920		Methylprednisolone injection
J2930		Methylprednisolone injection
J8520		Capecitabine, oral, 150 mg
J8521		Capecitabine, oral, 500 mg
J9058		Inj apotex/bendamustine 1 mg
J9059		Inj bendamustine, baxter 1mg
J9070		Cyclophosphamide 100 mg inj
J9250		Methotrexate sodium inj
J9258		Paclitaxel (teva)
J9259		Paclitaxel (american regent)
J9371		Inj, vincristine sul lip 1mg
M0003		Opt care episod neuro mvp
M1154		Hospc serv dur meas pd
M1155		Pt anphx due to pneum
M1219		Anphx due to vax
M1264		Pts 75+ dialysis dt
Q0516		Supply fee hiv prep oral 30
Q0517		Supply fee hiv prep oral 60
Q0518		Supply fee hiv prep oral 90
Q0519		Supply fee hiv prep inj 30
Q0520		Supply fee hiv prep inj 60
Q4210		Axolotl graf dualgraf sq cm
Q4244		Procenta, per 200 mg
Q4277		Woundplus e-grat, per sq cm
Q5131		Inj, idacio, 20 mg
Q5132		Inj, abrilada, 10 mg
S0164		Injection pantroprazole

We make treating injured workers easier, faster, and less costly. Request a free demonstration below.

REQUEST DEMO

0 Reader Comments

There are no comments for this article. Be the first to comment!

How did you like the article ?

DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.