2026 CA Physician Fee Schedule Changes Part 3: Newly Payable & Non-Payable Codes
California’s Division of Workers’ Compensation (CA DWC) issued an update to the Physician and Non-Physician Practitioner Fee Schedule for workers’ compensation, effective for all dates of service on or after March 1, 2026.
The Fee Schedule update
- Adds reimbursement for 367 HCPCS (aka procedure codes)
- Removes reimbursement for 231 HCPCS (aka procedure codes)
The update aligns the Physician Fee Schedule with changes to the Medicare payment system, as required by California Labor Code Section 5307.1. The CA DWC announced the update in a Newsline and posted the adoption order on its website.
Previous daisyNews articles on the Physician Fee Schedule updates include the following:
- Changes to the reimbursement rates for California-specific ‘WC’ billing codes
- The increase in the Conversion Factor used to determine reimbursement rates
- Reimbursement calculation changes for 305 HCPCS
The two tables below list the 367 newly payable HCPCS codes and the 231 HCPCS codes that will no longer be payable for dates of service on or after March 1, 2026.
As always, daisyBillers do not need to take any action; our billing software and Fee Schedule Calculator will incorporate all of the 2026 Physician Fee Schedule changes.
367 HCPCS - New Reimbursement Calculations
In the table below, each HCPCS code includes a ‘Base Maximum Fee Reimbursement Calculations’ column that indicates how to correctly calculate the reimbursement rate for the newly payable HCPCS.
For 143 HCPCS, the reimbursement is calculated using the following factors, expressed in the table as “RVU+GPCI+CF”:
- The Medicare Relative Value Units (RVUs)
- The Medicare Geographic Practice Cost Index (GPCI) for the location of service
- The 2026 California Conversion Factor (CF)
Reimbursement for 116 HCPCS codes will be determined “By Report.” The reimbursement rate for “By Report” codes is determined by identifying a comparable procedure in terms of the time, skill, and resources required and charging accordingly, per the instructions in California Code of Regulations (CCR) Section 9789.12.4.
For 28 HCPCS codes, the “Base Maximum Fee Reimbursement Calculation” refers to the section of California’s Official Medical Fee Schedule that establishes reimbursement conditions for the HCPCS code. These sections include:
- Physician Fee Schedule - CCR § 9789.12.3 for codes assigned applicable Status Indicators
- Physician Fee Schedule - CCR § 9789.13.2 for Physician-administered drugs, biologicals, vaccines, and blood products
- Pathology and Clinical Laboratory Services - CCR § 9789.50
- Durable Medical Equipment, Orthotics, Prosthetics, and Supplies (DMEPOS) - CCR § 9789.60
Additionally, 2 HCPCS codes are not separately reimbursable; payment for these codes will be “bundled” with payment for other codes.
Finally, 78 HCPCS codes for which Medicare assigns Status Code ‘M’ are not reimbursable at all, but are used for reporting purposes only.
367 HCPCS Base Maximum Fee Calculations
HCPCS |
Modifier |
Description |
Base Maximum Fee Reimbursement Calculation |
27458 |
Osteot femur imed lngth dev |
RVU+GPCI+CF |
|
27713 |
Osteot tibia imed lngth dev |
RVU+GPCI+CF |
|
33882 |
Evasc rpr ta dplmt mltpc sys |
RVU+GPCI+CF |
|
35602 |
Bpg crtd-clat crtd |
RVU+GPCI+CF |
|
37254 |
Revsc evasc ivt angio sf 1st |
RVU+GPCI+CF |
|
37255 |
Revsc evasc ivt angio sf ea |
RVU+GPCI+CF |
|
37256 |
Revsc evasc ivt angio cplx 1 |
RVU+GPCI+CF |
|
37257 |
Revsc evsc ivt angio cplx ea |
RVU+GPCI+CF |
|
37258 |
Revsc evasc ivt stent sf 1st |
RVU+GPCI+CF |
|
37259 |
Revsc evasc ivt stent sf ea |
RVU+GPCI+CF |
|
37260 |
Revsc evasc ivt st cplx 1st |
RVU+GPCI+CF |
|
37261 |
Revsc evasc ivt st cplx ea |
RVU+GPCI+CF |
|
37262 |
Iv lithotrp ivt w/in sm art |
RVU+GPCI+CF |
|
37263 |
Revsc evasc fpvt angio sf 1 |
RVU+GPCI+CF |
|
37264 |
Revsc evasc fpvt angio sf ea |
RVU+GPCI+CF |
|
37265 |
Revsc evsc fpvt angio cplx 1 |
RVU+GPCI+CF |
|
37266 |
Rvsc evsc fpvt angio cplx ea |
RVU+GPCI+CF |
|
37267 |
Revsc evsc fpvt stent sf 1st |
RVU+GPCI+CF |
|
37268 |
Revsc evasc fpvt stent sf ea |
RVU+GPCI+CF |
|
37269 |
Revsc evasc fpvt st cplx 1st |
RVU+GPCI+CF |
|
37270 |
Revsc evasc fpvt st cplx ea |
RVU+GPCI+CF |
|
37271 |
Revsc evsc fpvt athrc sf 1st |
RVU+GPCI+CF |
|
37272 |
Revsc evsc fpvt athrc sf ea |
RVU+GPCI+CF |
|
37273 |
Revsc evsc fpvt athrc cplx 1 |
RVU+GPCI+CF |
|
37274 |
Rvsc evsc fpvt athrc cplx ea |
RVU+GPCI+CF |
|
37275 |
Rvsc evsc fpvt st athrc sf 1 |
RVU+GPCI+CF |
|
37276 |
Rvsc evsc fpvt st athr sf ea |
RVU+GPCI+CF |
|
37277 |
Rvsc evsc fpvt st athr cpx 1 |
RVU+GPCI+CF |
|
37278 |
Rvsc evsc fpvt st ath cpx ea |
RVU+GPCI+CF |
|
37279 |
Iv lithotrp fpvt w/in sm art |
RVU+GPCI+CF |
|
37280 |
Revsc evsc tpvt angio sf 1st |
RVU+GPCI+CF |
|
37281 |
Revsc evsc tpvt angio sf ea |
RVU+GPCI+CF |
|
37282 |
Rvsc evsc tpvt angio cplx 1 |
RVU+GPCI+CF |
|
37283 |
Rvsc evsc tpvt angio cplx ea |
RVU+GPCI+CF |
|
37284 |
Revsc evasc tpvt st sf 1st |
RVU+GPCI+CF |
|
37285 |
Revsc evasc tpvt st sf ea |
RVU+GPCI+CF |
|
37286 |
Revsc evasc tpvt st cplx 1st |
RVU+GPCI+CF |
|
37287 |
Revsc evasc tpvt st cplx ea |
RVU+GPCI+CF |
|
37288 |
Revsc evsc tpvt athrc sf 1st |
RVU+GPCI+CF |
|
37289 |
Revsc evsc tpvt athrc sf ea |
RVU+GPCI+CF |
|
37290 |
Revsc evsc tpvt athrc cplx 1 |
RVU+GPCI+CF |
|
37291 |
Revsc evsc tpvt athr cplx ea |
RVU+GPCI+CF |
|
37292 |
Rvsc evsc tpvt st athrc sf 1 |
RVU+GPCI+CF |
|
37293 |
Rvsc evsc tpvt st athr sf ea |
RVU+GPCI+CF |
|
37294 |
Rvsc evsc tpvt st athr cpx 1 |
RVU+GPCI+CF |
|
37295 |
Rvsc evsc tpvt st ath cpx ea |
RVU+GPCI+CF |
|
37296 |
Revsc evasc imvt angio sf 1 |
RVU+GPCI+CF |
|
37297 |
Revsc evasc imvt angio sf ea |
RVU+GPCI+CF |
|
37298 |
Revsc evsc imvt angio cplx 1 |
RVU+GPCI+CF |
|
37299 |
Revsc evsc imvt angio cpx ea |
RVU+GPCI+CF |
|
43889 |
Gstr rstcv px trnsorl esg |
RVU+GPCI+CF |
|
47384 |
Abltj ire liver 1+ tum perq |
RVU+GPCI+CF |
|
52443 |
Cysto 1st trurl prst8 comis |
RVU+GPCI+CF |
|
52597 |
Trurl rbtc wtrjt rescj prst8 |
RVU+GPCI+CF |
|
55707 |
Bx prst8 trct us guided |
RVU+GPCI+CF |
|
55708 |
Bx prst8 trct us w/mri fus 1 |
RVU+GPCI+CF |
|
55709 |
Bx prst8 tprnl us guided |
RVU+GPCI+CF |
|
55710 |
Bx prst8 tprn us w/mri fus 1 |
RVU+GPCI+CF |
|
55711 |
Bx prst8 trct mri-us 1st |
RVU+GPCI+CF |
|
55712 |
Bx prst8 tprnl mri-us 1st |
RVU+GPCI+CF |
|
55713 |
Bx prst8 in-bore ct/mri bx 1 |
RVU+GPCI+CF |
|
55714 |
Bx prst8 in-bore ct/mri 1 |
RVU+GPCI+CF |
|
55715 |
Bx prst8 ea add mri-us/ct/mr |
RVU+GPCI+CF |
|
55868 |
Lap srg prst8ct lymph nod bx |
RVU+GPCI+CF |
|
55869 |
Lap srg prst8ct bi pl lmphad |
RVU+GPCI+CF |
|
55877 |
Abltj ire prst8 1+ tum perq |
RVU+GPCI+CF |
|
62330 |
Dcmprn prq rmv lig flv 1lmbr |
RVU+GPCI+CF |
|
62331 |
Dcmprn prq rmv lig flv addl |
RVU+GPCI+CF |
|
63032 |
Lamot rpr anulr dfct 1 lmbr |
RVU+GPCI+CF |
|
64567 |
Perq elec nrv field stimj cn |
RVU+GPCI+CF |
|
64654 |
1st opn implt bat modulj sys |
RVU+GPCI+CF |
|
64655 |
Revj/rplcmt bat mod sys lead |
RVU+GPCI+CF |
|
64656 |
Revj/rplcmt bat mod sys pg |
RVU+GPCI+CF |
|
64657 |
Rmvl bat modulj sys tot sys |
RVU+GPCI+CF |
|
64658 |
Rmvl bat modul sys lead only |
RVU+GPCI+CF |
|
64659 |
Rmvl bat modulj sys pg only |
RVU+GPCI+CF |
|
64728 |
Dcmprn median nrv carpl tunl |
RVU+GPCI+CF |
|
70471 |
Cta h&n c+ w/noncontrast img |
RVU+GPCI+CF |
|
70471 |
26 |
Cta h&n c+ w/noncontrast img |
RVU+GPCI+CF |
70471 |
TC |
Cta h&n c+ w/noncontrast img |
RVU+GPCI+CF |
70472 |
TC |
Ct cere prfu alys c+w/ct/cta |
RVU+GPCI+CF |
70472 |
Ct cere prfu alys c+w/ct/cta |
RVU+GPCI+CF |
|
70472 |
26 |
Ct cere prfu alys c+w/ct/cta |
RVU+GPCI+CF |
70473 |
TC |
Ct cere prfu aly c+wo ct/cta |
RVU+GPCI+CF |
70473 |
26 |
Ct cere prfu aly c+wo ct/cta |
RVU+GPCI+CF |
70473 |
Ct cere prfu aly c+wo ct/cta |
RVU+GPCI+CF |
|
75577 |
26 |
Quan&char c athrosclrtc plaq |
RVU+GPCI+CF |
75577 |
Quan&char c athrosclrtc plaq |
RVU+GPCI+CF |
|
75577 |
TC |
Quan&char c athrosclrtc plaq |
RVU+GPCI+CF |
77387 |
TC |
Guidance for radj tx dlvr |
Bundled Code |
77387 |
26 |
Guidance for radj tx dlvr |
RVU+GPCI+CF |
77436 |
TC |
Surf radj ther tx planning |
RVU+GPCI+CF |
77436 |
Surf radj ther tx planning |
RVU+GPCI+CF |
|
77436 |
26 |
Surf radj ther tx planning |
RVU+GPCI+CF |
77437 |
Surf radj ther supfc<=150kv |
RVU+GPCI+CF |
|
77438 |
Surf rad thr orthvlt>150-500 |
RVU+GPCI+CF |
|
77439 |
TC |
Surf rad thr img gdn us plmt |
Bundled Code |
77439 |
26 |
Surf rad thr img gdn us plmt |
RVU+GPCI+CF |
77439 |
Surf rad thr img gdn us plmt |
RVU+GPCI+CF |
|
81354 |
Cytog alys chrml abnor ogm |
Section 9789.50 establishes payment conditions |
|
81524 |
Onc cns tum dna mthyl 10,000 |
Section 9789.50 establishes payment conditions |
|
87182 |
Sc std carbapenemase nzm det |
Section 9789.50 establishes payment conditions |
|
87183 |
Sc std carbapenem resist gen |
Section 9789.50 establishes payment conditions |
|
87494 |
Chlmy trch&neisra gonor mult |
Section 9789.50 establishes payment conditions |
|
87627 |
Jt spc pthgn&rx rsist gen26+ |
Section 9789.50 establishes payment conditions |
|
87812 |
Sarscov2&inf typ a&b w/optic |
Section 9789.50 establishes payment conditions |
|
90481 |
Admn sarscov2 vac ea add cmp |
By Report |
|
90482 |
Imm cnsl not admn sm 3<10 |
Section 9789.12.3. establishes payment conditions |
|
90483 |
Imm cnsl not admn sm>10<20 |
Section 9789.12.3. establishes payment conditions |
|
90484 |
Imm cnsl not admn sm>20 |
Section 9789.12.3. establishes payment conditions |
|
90631 |
H5 vaccine pandemic im use |
By Report |
|
90695 |
H5n8 vacc drv cll cul adj im |
By Report |
|
91124 |
TC |
Rct snsatn tone&cmplianc std |
RVU+GPCI+CF |
91124 |
26 |
Rct snsatn tone&cmplianc std |
RVU+GPCI+CF |
91124 |
Rct snsatn tone&cmplianc std |
RVU+GPCI+CF |
|
91125 |
TC |
Anrct mano rct snsatn&balo |
RVU+GPCI+CF |
91125 |
26 |
Anrct mano rct snsatn&balo |
RVU+GPCI+CF |
91125 |
Anrct mano rct snsatn&balo |
RVU+GPCI+CF |
|
92284 |
TC |
Dx dark adaptation exam i&r |
RVU+GPCI+CF |
92284 |
26 |
Dx dark adaptation exam i&r |
RVU+GPCI+CF |
92288 |
Scr dark adaptation meas i&r |
RVU+GPCI+CF |
|
92628 |
Eval hearing aid cand 1st 30 |
By Report |
|
92629 |
Eval hearing aid cand ea add |
By Report |
|
92631 |
Hearing aid slctn svc 1st 30 |
By Report |
|
92632 |
Hearing aid slctn svc ea add |
By Report |
|
92634 |
Hearing aid fitg svc 1st 60 |
By Report |
|
92635 |
Hearing aid fitg svc ea addl |
By Report |
|
92636 |
Hearing aid post-fitg f-up 1 |
By Report |
|
92637 |
Hearing aid pst-fitg f-up ea |
By Report |
|
92638 |
Bhvl verif of amplification |
By Report |
|
92639 |
Hearing aid meas verif |
By Report |
|
92641 |
Hearing dev verif eacous aly |
By Report |
|
92642 |
Hearing asstv dev fitg svc |
By Report |
|
92930 |
Prq tcat plmt ntrac st 2+les |
RVU+GPCI+CF |
|
92945 |
Prq trl rvs ch occ ant&rtrgr |
RVU+GPCI+CF |
|
93145 |
Interrog crtd sins bat ip wo |
RVU+GPCI+CF |
|
93146 |
Interrog crtd sins bat ip w/ |
RVU+GPCI+CF |
|
97007 |
Mchnl sclp cool meas fitg |
RVU+GPCI+CF |
|
97008 |
Mchnl sclp cool prep plmt |
RVU+GPCI+CF |
|
97009 |
Mchnl sclp cool after chemo |
RVU+GPCI+CF |
|
98979 |
Rtm tx mgmt 1st 10 min |
RVU+GPCI+CF |
|
98984 |
Rtm dev sply resp sys 2-15 d |
RVU+GPCI+CF |
|
98985 |
Rtm dev sply mscsk sys 2-15d |
RVU+GPCI+CF |
|
98986 |
Rtm dev sply cbt 2-15 d |
By Report |
|
99445 |
Rem mntr physiol param 2-15 |
RVU+GPCI+CF |
|
99470 |
Rpm tx mgmt 1st 10 min |
RVU+GPCI+CF |
|
0988T |
Opn ins/rplc ins ptn sbq&sbf |
By Report |
|
0989T |
Revj/rmvl ins ptn subq&subf |
By Report |
|
0990T |
Trncrv inst biod hydrgl mtrl |
By Report |
|
0991T |
Cysto lo-nrg lithtrp&mcrsphr |
By Report |
|
0992T |
26 |
N-invas assmt car rsk w/o ct |
By Report |
0992T |
TC |
N-invas assmt car rsk w/o ct |
By Report |
0992T |
N-invas assmt car rsk w/o ct |
By Report |
|
0993T |
TC |
N-invas assmt car rsk w/ct |
By Report |
0993T |
26 |
N-invas assmt car rsk w/ct |
By Report |
0993T |
N-invas assmt car rsk w/ct |
By Report |
|
0994T |
Evasc dlvr a-wal stbl rx prq |
By Report |
|
0995T |
Evasc dlvr a-wal stbl rx opn |
By Report |
|
0996T |
Ins&sclr fix caps bag prosth |
By Report |
|
0997T |
Precuneus mag stimj tx plng |
By Report |
|
0998T |
Precuneus mag stimj tx dlvr |
By Report |
|
0999T |
Autol musc cell therapy hrvg |
By Report |
|
1000T |
Autol musc cell therapy admn |
By Report |
|
1001T |
Autol musc cell therapy njx |
By Report |
|
1002T |
26 |
Air displacmnt plethysmograp |
By Report |
1002T |
TC |
Air displacmnt plethysmograp |
By Report |
1002T |
Air displacmnt plethysmograp |
By Report |
|
1003T |
Arthrp 1st crp/mtcrpl prostc |
By Report |
|
1004T |
Elec alys s-scl eeg wo prgrm |
By Report |
|
1005T |
Elec alys s-scl eeg prgr 1st |
By Report |
|
1006T |
Elec alys s-scl eeg prgrm ea |
By Report |
|
1007T |
Eeg impl s-sclp eeg w/o vid |
By Report |
|
1008T |
Rem mntr s-scl eeg sys setup |
By Report |
|
1009T |
Rem mntr s-sclp cont eeg sys |
By Report |
|
1010T |
26 |
Cptr oph alys monoc eye mvmt |
By Report |
1010T |
Cptr oph alys monoc eye mvmt |
By Report |
|
1010T |
TC |
Cptr oph alys monoc eye mvmt |
By Report |
1011T |
Pbm therapy of oral cavity |
By Report |
|
1012T |
Mtrz ab ntrno trph scl/tr mw |
By Report |
|
1013T |
Lap srg imp/rpl eso nea&pg/r |
By Report |
|
1014T |
Lap rv/rmv eso sph nstm eltr |
By Report |
|
1015T |
Rev/rmv lw esoph sphnc npg/r |
By Report |
|
1016T |
Elec alys npgs esoph intraop |
By Report |
|
1017T |
Elec aly npgs esoph sbsq w/o |
By Report |
|
1018T |
Elec alys npgs esoph sbsq w/ |
By Report |
|
1019T |
Lymphovenous bypass per xtr |
By Report |
|
1020T |
Raman spectroscopy 1+skn les |
By Report |
|
1021T |
Active thrc irrigation spx |
By Report |
|
1022T |
Prq tis dsplmt ntra-abdl/pel |
By Report |
|
1023T |
Prq tis dsplmt intrathoracic |
By Report |
|
1024T |
Perq tiss dsplmt soft tissue |
By Report |
|
1025T |
TC |
Alt elec fld dos&dlv sim mdl |
By Report |
1025T |
Alt elec fld dos&dlv sim mdl |
By Report |
|
1025T |
26 |
Alt elec fld dos&dlv sim mdl |
By Report |
A4295 |
Straigh tip hydrophilic cath |
Section 9789.60 establishes payment conditions |
|
A4296 |
Coude tip hydrophilic cath |
Section 9789.60 establishes payment conditions |
|
A4297 |
Hydrophilic coat insert sup |
Section 9789.60 establishes payment conditions |
|
D0426 |
Coll, analys of saliva |
By Report |
|
D0461 |
Testing for cracked tooth |
By Report |
|
D1720 |
Influenza vacc admin |
By Report |
|
D5877 |
Dup of complt dent-maxill |
By Report |
|
D5878 |
Dup of complt dent-mandib |
By Report |
|
D5909 |
Max guid prothes w/ flange |
By Report |
|
D5930 |
Max guid prothes w/o flange |
By Report |
|
D5938 |
Resct proth max comp remov |
By Report |
|
D5939 |
Resct proth mand comp remov |
By Report |
|
D5940 |
Resct proth max part remov |
By Report |
|
D5941 |
Resct proth mand part remov |
By Report |
|
D5942 |
Proth max implt sup remv |
By Report |
|
D5943 |
Proth mandib implt sup remv |
By Report |
|
D5944 |
Max implt sup remv part |
By Report |
|
D5945 |
Mand implt sup remv part |
By Report |
|
D5946 |
Max implt sup fix |
By Report |
|
D5947 |
Mand implt sup fix |
By Report |
|
D5948 |
Max implt sup fix part |
By Report |
|
D5949 |
Mand implt sup fix part |
By Report |
|
D6049 |
Scale implt peri-implt inflm |
By Report |
|
D6196 |
Remv of ind rest on implt |
By Report |
|
D6280 |
Implt maint procd remv implt |
By Report |
|
D9128 |
Photobio therpy-first 15 min |
By Report |
|
D9129 |
Photobio therpy-sub 15 mins |
By Report |
|
D9224 |
Gen anes adv air-15 min |
By Report |
|
D9225 |
Gen anes adv air-sub 15 min |
By Report |
|
D9244 |
Office min sed drug enteral |
By Report |
|
D9245 |
Admin mod sedation-enteral |
By Report |
|
D9246 |
Mod sedation noniv-15 min |
By Report |
|
D9247 |
Mod sedation noniv-sub15min |
By Report |
|
D9936 |
Clean occ guard |
By Report |
|
G0568 |
Int psych care mng, 1 cal mo |
RVU+GPCI+CF |
|
G0569 |
Subs psych care mng, subs mo |
RVU+GPCI+CF |
|
G0570 |
Care manage serv, pr cal mo |
RVU+GPCI+CF |
|
G0571 |
Intraop nerve cryoablation |
RVU+GPCI+CF |
|
G0660 |
Team remote e/m new pt 10 mn |
By Report |
|
G0661 |
Team remote e/m new pt 20 mn |
By Report |
|
G0662 |
Team remote e/m new pt 30 mn |
By Report |
|
G0663 |
Team remote e/m new pt 45 mn |
By Report |
|
G0664 |
Team remote e/m new pt 60 mn |
By Report |
|
G0665 |
Team remote e/m est pt 10 mn |
By Report |
|
G0666 |
Team remote e/m est pt 15 mn |
By Report |
|
G0667 |
Team remote e/m est pt 25 mn |
By Report |
|
G0668 |
Team remote e/m est pt 40 mn |
By Report |
|
G9871 |
Bhv couns dm prev, onln 60 m |
By Report |
|
GXXX1 |
Bhv couns dm prev, onln 60 m |
By Report |
|
J0013 |
Esketamine, nasal spray |
By Report |
|
J0162 |
Inj epinephrine (fresenius) |
Section 9789.13.2. establishes payment conditions |
|
J0654 |
Inj, liothyronine, 1 mcg |
Section 9789.13.2. establishes payment conditions |
|
J1073 |
Testosterone pellet 75 mg |
Section 9789.13.2. establishes payment conditions |
|
J1736 |
Inj meloxicam (delova) 1mg |
By Report |
|
J1737 |
Inj meloxicam (azurity) 1mg |
Section 9789.13.2. establishes payment conditions |
|
J1837 |
Inj, posaconazole, 1 mg |
Section 9789.13.2. establishes payment conditions |
|
J2516 |
Inj, pentamidine isethionate |
Section 9789.13.2. establishes payment conditions |
|
J2596 |
Vasopressin (long grove) 1 u |
Section 9789.13.2. establishes payment conditions |
|
J2711 |
Inj neostigmin/glycopyrrolat |
Section 9789.13.2. establishes payment conditions |
|
J3291 |
Tranexamic acid in sod chlor |
By Report |
|
J3376 |
Inj vancomycin (hikma) 10mg |
Section 9789.13.2. establishes payment conditions |
|
J3379 |
Inj, valproate sod, 5 mg |
Section 9789.13.2. establishes payment conditions |
|
J3387 |
Inj elivaldogene autotemecel |
By Report |
|
J3389 |
Topi adm prad zami per treat |
By Report |
|
J7299 |
Intraut copp cont (miudella) |
By Report |
|
J7528 |
Mycophen mofetil for susp |
Section 9789.13.2. establishes payment conditions |
|
J9184 |
Inj gemcitabin (avyxa) 200mg |
Section 9789.13.2. establishes payment conditions |
|
J9256 |
Inj, nipocalimab-aahu, 3 mg |
Section 9789.13.2. establishes payment conditions |
|
J9282 |
Mitomycin intravesical inst |
Section 9789.13.2. establishes payment conditions |
|
J9326 |
Telisotuzumab vedotin-tllv |
Section 9789.13.2. establishes payment conditions |
|
M1426 |
Telehealth enc |
Reporting purposes only |
|
M1427 |
Doc med rsn bone scn |
Reporting purposes only |
|
M1428 |
Bilateral absence of eyes |
Reporting purposes only |
|
M1429 |
Retinopathy in od, os, ou |
Reporting purposes only |
|
M1430 |
Ret exm ou no retinopthy doc |
Reporting purposes only |
|
M1431 |
Telehealth enc |
Reporting purposes only |
|
M1432 |
Telehealth enc |
Reporting purposes only |
|
M1433 |
Oral chemo wthn 30 days enc |
Reporting purposes only |
|
M1434 |
Orl chemo wthn 30 d post enc |
Reporting purposes only |
|
M1435 |
Oral chemo in perf pd |
Reporting purposes only |
|
M1436 |
Telehealth enc |
Reporting purposes only |
|
M1437 |
Telehealth enc |
Reporting purposes only |
|
M1438 |
Lst knwn well <=210 min |
Reporting purposes only |
|
M1439 |
Sig ocu cond imp surg out |
Reporting purposes only |
|
M1440 |
Telehealth enc |
Reporting purposes only |
|
M1441 |
Init dx slp apn = 1st enc |
Reporting purposes only |
|
M1442 |
Telehealth enc |
Reporting purposes only |
|
M1443 |
Telehealth enc |
Reporting purposes only |
|
M1444 |
Del < 39 weeks gest |
Reporting purposes only |
|
M1445 |
Pp care visit by 12 weeks |
Reporting purposes only |
|
M1446 |
Pt died bef end meas pd |
Reporting purposes only |
|
M1447 |
Pt dx bd bef end meas pd |
Reporting purposes only |
|
M1448 |
Pt dx pd bef end meas pd |
Reporting purposes only |
|
M1449 |
Pt dx scz/pys bef end msr pd |
Reporting purposes only |
|
M1450 |
Pt hos/pal care dur id/pf pd |
Reporting purposes only |
|
M1451 |
Pt dx ppd dur id/pf pd |
Reporting purposes only |
|
M1452 |
Pt dx dementia ever |
Reporting purposes only |
|
M1453 |
Preop vis acu > 20/40 |
Reporting purposes only |
|
M1454 |
New cied |
Reporting purposes only |
|
M1455 |
Rep/rev cied |
Reporting purposes only |
|
M1456 |
Pt had htx |
Reporting purposes only |
|
M1457 |
Dx asth dur crnt/prv perf pd |
Reporting purposes only |
|
M1458 |
Pt died bef end meas pd |
Reporting purposes only |
|
M1459 |
Pt hosp/pal care dur perf pd |
Reporting purposes only |
|
M1460 |
Dx copd, cf, or arf |
Reporting purposes only |
|
M1461 |
Pt dx chron hepc |
Reporting purposes only |
|
M1462 |
Pt clin ind hd image |
Reporting purposes only |
|
M1463 |
2 f/u wthn 180 day rx atmp |
Reporting purposes only |
|
M1464 |
No record of f/u by 180 days |
Reporting purposes only |
|
M1465 |
F/u > 180 days after rx |
Reporting purposes only |
|
M1466 |
Pt disc/lam proc same day |
Reporting purposes only |
|
M1467 |
Pt dx lynch syn |
Reporting purposes only |
|
M1468 |
Hep b vaccine received |
Reporting purposes only |
|
M1469 |
Hx of hep b, or pos bld test |
Reporting purposes only |
|
M1470 |
Hep b vac not rec'd med rsn |
Reporting purposes only |
|
M1471 |
Ffs hep b not covered |
Reporting purposes only |
|
M1472 |
Hep b vaccine not received |
Reporting purposes only |
|
M1473 |
Pt func cap not allow impr |
Reporting purposes only |
|
M1474 |
Pt dx dementia |
Reporting purposes only |
|
M1475 |
Pt dx huntington |
Reporting purposes only |
|
M1476 |
Pt dx cog imp or ad |
Reporting purposes only |
|
M1477 |
Dx delirium |
Reporting purposes only |
|
M1478 |
Psychoactive sub abuse |
Reporting purposes only |
|
M1479 |
Pt func cap not allow impr |
Reporting purposes only |
|
M1480 |
Pt func cap not allow impr |
Reporting purposes only |
|
M1481 |
Pt in hosp/pal care who died |
Reporting purposes only |
|
M1482 |
Pos quan hep c or qual rna |
Reporting purposes only |
|
M1483 |
Neg quan hep c or qual rna |
Reporting purposes only |
|
M1484 |
No rpt hcv rna perf med rsn |
Reporting purposes only |
|
M1485 |
Neg viro resp hep c/qual rna |
Reporting purposes only |
|
M1486 |
Pt admitted to snf dur eval |
Reporting purposes only |
|
M1487 |
Pt adm to hospice dur eval |
Reporting purposes only |
|
M1488 |
Dx dementia in msr timeframe |
Reporting purposes only |
|
M1489 |
Pt status doc |
Reporting purposes only |
|
M1490 |
Pt status not doc |
Reporting purposes only |
|
M1491 |
Rec'd esrd mcp dur perf pd |
Reporting purposes only |
|
M1492 |
No reported fall |
Reporting purposes only |
|
M1493 |
No fall doc med rsn |
Reporting purposes only |
|
M1494 |
Fall rep since last visit |
Reporting purposes only |
|
M1495 |
Fall w/ poc, no fall |
Reporting purposes only |
|
M1496 |
No doc of fall or poc |
Reporting purposes only |
|
M1497 |
No doc fall med rsn |
Reporting purposes only |
|
M1498 |
Diagnostic radiology mvp |
Reporting purposes only |
|
M1499 |
Interventional radiology mvp |
Reporting purposes only |
|
M1500 |
Neuropsychology mvp |
Reporting purposes only |
|
M1501 |
Pathology mvp |
Reporting purposes only |
|
M1502 |
Podiatry mvp |
Reporting purposes only |
|
M1503 |
Vascular surgery mvp |
Reporting purposes only |
|
Q4398 |
Summit ac per sq cm |
RVU+GPCI+CF |
|
Q4399 |
Summit fx per sq cm |
RVU+GPCI+CF |
|
Q4400 |
Polygon3 per sq cm |
RVU+GPCI+CF |
|
Q4401 |
Absolv3 per sq cm |
RVU+GPCI+CF |
|
Q4402 |
Xwrap 2.0 per sq cm |
RVU+GPCI+CF |
|
Q4403 |
Xwrap dual plus per sq cm |
RVU+GPCI+CF |
|
Q4404 |
Xwrap hydro plus per sq cm |
RVU+GPCI+CF |
|
Q4405 |
Xwrap fenestra plus sq cm |
RVU+GPCI+CF |
|
Q4406 |
Xwrap fenestra per sq cm |
RVU+GPCI+CF |
|
Q4407 |
Xwrap tribus per sq cm |
RVU+GPCI+CF |
|
Q4408 |
Xwrap hydro per sq cm |
RVU+GPCI+CF |
|
Q4409 |
Amniomatrixf3x per sq cm |
RVU+GPCI+CF |
|
Q4410 |
Amchomatrixdl per sq cm |
RVU+GPCI+CF |
|
Q4411 |
Amniomatrixf4x per sq cm |
RVU+GPCI+CF |
|
Q4412 |
Choriofix per sq cm |
RVU+GPCI+CF |
|
Q4413 |
Cygnus solo per sq cm |
RVU+GPCI+CF |
|
Q4414 |
Simplichor per sq cm |
RVU+GPCI+CF |
|
Q4415 |
Alexiguard st-l per sq cm |
RVU+GPCI+CF |
|
Q4416 |
Alexiguard tl-t per sq cm |
RVU+GPCI+CF |
|
Q4417 |
Alexiguard dl-t per sq cm |
RVU+GPCI+CF |
|
Q4420 |
Nuform per sq cm |
RVU+GPCI+CF |
|
Q4431 |
Pma skin substitute, nos |
By Report |
|
Q4432 |
510(k) skin subs, nos |
By Report |
|
Q4433 |
361 hct/p skin subs, nos |
By Report |
|
Q5160 |
Inj, jobevne, 10 mg |
By Report |
231 Deleted HCPCS Codes
The update to the Physician Fee Schedule renders the 231 HCPCS codes listed below non-reimbursable. The California Physician Fee Schedule no longer reimburses for these codes.
HCPCS |
Modifier |
Description |
27445 |
Revision of knee joint |
|
27468 |
Shorten/lengthen thighs |
|
33884 |
Endovasc prosth taa add-on |
|
33889 |
Artery transpose/endovas taa |
|
33891 |
Car-car bp grft/endovas taa |
|
37220 |
Iliac revasc |
|
37221 |
Iliac revasc w/stent |
|
37222 |
Iliac revasc add-on |
|
37223 |
Iliac revasc w/stent add-on |
|
37224 |
Fem/popl revas w/tla |
|
37225 |
Fem/popl revas w/ather |
|
37226 |
Fem/popl revasc w/stent |
|
37227 |
Fem/popl revasc stnt & ather |
|
37228 |
Tib/per revasc w/tla |
|
37229 |
Tib/per revasc w/ather |
|
37230 |
Tib/per revasc w/stent |
|
37231 |
Tib/per revasc stent & ather |
|
37232 |
Tib/per revasc add-on |
|
37233 |
Tibper revasc w/ather add-on |
|
37234 |
Revsc opn/prq tib/pero stent |
|
37235 |
Tib/per revasc stnt & ather |
|
37500 |
Endoscopy ligate perf veins |
|
52647 |
Laser surgery of prostate |
|
55700 |
Biopsy of prostate |
|
75842 |
Vein x-ray adrenal glands |
|
75842 |
26 |
Vein x-ray adrenal glands |
75842 |
TC |
Vein x-ray adrenal glands |
75956 |
Xray endovasc thor ao repr |
|
75956 |
26 |
Xray endovasc thor ao repr |
75956 |
TC |
Xray endovasc thor ao repr |
75957 |
Xray endovasc thor ao repr |
|
75957 |
TC |
Xray endovasc thor ao repr |
75957 |
26 |
Xray endovasc thor ao repr |
75958 |
26 |
Xray place prox ext thor ao |
75958 |
TC |
Xray place prox ext thor ao |
75958 |
Xray place prox ext thor ao |
|
75959 |
TC |
Xray place dist ext thor ao |
75959 |
Xray place dist ext thor ao |
|
75959 |
26 |
Xray place dist ext thor ao |
77014 |
Ct scan for therapy guide |
|
77014 |
TC |
Ct scan for therapy guide |
77014 |
26 |
Ct scan for therapy guide |
77385 |
Ntsty modul rad tx dlvr smpl |
|
77386 |
Ntsty modul rad tx dlvr cplx |
|
77401 |
Radiation tx delivery supfc |
|
91120 |
Rectal sensation test |
|
91120 |
26 |
Rectal sensation test |
91120 |
TC |
Rectal sensation test |
91122 |
Anorectal manometry |
|
91122 |
TC |
Anorectal manometry |
91122 |
26 |
Anorectal manometry |
92590 |
Hearing aid xm&slctn monaurl |
|
92591 |
Hearing aid xm&slctn binaurl |
|
92592 |
Hearing aid check monaural |
|
92593 |
Hearing aid check binaural |
|
92594 |
Electro hearng aid test one |
|
92595 |
Electro hearng aid tst both |
|
92921 |
Prq cardiac angio addl art |
|
92925 |
Prq card angio/athrect addl |
|
92929 |
Prq card stent w/angio addl |
|
92934 |
Prq card stent/ath/angio |
|
92938 |
Prq revasc byp graft addl |
|
92944 |
Prq card revasc chronic addl |
|
92975 |
Dissolve clot heart vessel |
|
92977 |
Dissolve clot heart vessel |
|
94662 |
Neg press ventilation cnp |
|
0042T |
Ct perfusion w/contrast cbf |
|
0266T |
Implt/rpl crtd sns dev total |
|
0267T |
Implt/rpl crtd sns dev lead |
|
0268T |
Implt/rpl crtd sns dev gen |
|
0269T |
Rev/remvl crtd sns dev total |
|
0270T |
Rev/remvl crtd sns dev lead |
|
0271T |
Rev/remvl crtd sns dev gen |
|
0272T |
Interrogate crtd sns dev |
|
0273T |
Interrogate crtd sns w/pgrmg |
|
0275T |
Perq lamot/lam lumbar |
|
0394T |
Hdr elctrnc skn surf brchytx |
|
0421T |
Waterjet prostate abltj cmpl |
|
0619T |
Cysto w/prst8 commissurotomy |
|
0623T |
Auto quantification c plaque |
|
0624T |
Auto quan c plaq data prep |
|
0625T |
Auto quan c plaq cptr alys |
|
0626T |
Auto quan c plaq i&r |
|
0631T |
Tc vis lit hyperspectral img |
|
0662T |
Scalp cool 1st meas&calbrj |
|
0663T |
Scalp cool plmt mntr rmvl |
|
0720T |
Prq elc nrv stim cn wo implt |
|
A9155 |
Artificial saliva |
|
D1352 |
Prev resin rest, perm tooth |
|
D1705 |
Astrazeneca vacc adm 1st dos |
|
D1706 |
Astrazeneca vacc adm 2nd dos |
|
D1707 |
Janssen vaccine admin |
|
D1712 |
Janssen vacc admin booster |
|
D9248 |
Sedation (non-iv) |
|
G0071 |
Comm svcs by rhc/fqhc 5 min |
|
G0511 |
Ccm/bhi by rhc/fqhc 20min mo |
|
G0512 |
Cocm by rhc/fqhc 60 min mo |
|
G0564 |
365 d implant glucose sensor |
|
G0565 |
Rem/ins glu snsr 365 dif sit |
|
G6001 |
TC |
Echo guidance radiotherapy |
G6001 |
26 |
Echo guidance radiotherapy |
G6001 |
Echo guidance radiotherapy |
|
G6002 |
26 |
Stereoscopic x-ray guidance |
G6002 |
Stereoscopic x-ray guidance |
|
G6002 |
TC |
Stereoscopic x-ray guidance |
G6003 |
Radiation treatment delivery |
|
G6004 |
Radiation treatment delivery |
|
G6005 |
Radiation treatment delivery |
|
G6006 |
Radiation treatment delivery |
|
G6007 |
Radiation treatment delivery |
|
G6008 |
Radiation treatment delivery |
|
G6009 |
Radiation treatment delivery |
|
G6010 |
Radiation treatment delivery |
|
G6011 |
Radiation treatment delivery |
|
G6012 |
Radiation treatment delivery |
|
G6013 |
Radiation treatment delivery |
|
G6014 |
Radiation treatment delivery |
|
G6015 |
Radiation tx delivery imrt |
|
G6016 |
Delivery comp imrt |
|
G6017 |
Intrafraction track motion |
|
G9037 |
Intrpro req fr rec phys/qhcp |
|
G9038 |
Co-management services |
|
G9604 |
Pt surv results not avail |
|
J0171 |
Adrenalin epinephrine inject |
|
J0172 |
Inj, aducanumab-avwa, 2 mg |
|
J0173 |
Inj, epinephrine (belcher) |
|
J0190 |
Inj biperiden lactate/5 mg |
|
J0200 |
Alatrofloxacin mesylate |
|
J0205 |
Alglucerase injection |
|
J0215 |
Alefacept |
|
J0288 |
Ampho b cholesteryl sulfate |
|
J0350 |
Injection anistreplase 30 u |
|
J0365 |
Aprotonin, 10,000 kiu |
|
J0380 |
Inj metaraminol bitartrate |
|
J0395 |
Arbutamine hcl injection |
|
J0710 |
Cephapirin sodium injection |
|
J0715 |
Ceftizoxime sodium / 500 mg |
|
J0795 |
Corticorelin ovine triflutal |
|
J0889 |
Daprodustat oral 1mg esrd |
|
J1094 |
Inj dexamethasone acetate |
|
J1267 |
Doripenem injection |
|
J1300 |
Eculizumab injection |
|
J1330 |
Ergonovine maleate injection |
|
J1443 |
Inj ferric pyrophosphate cit |
|
J1444 |
Fe pyro cit pow 0.1 mg iron |
|
J1445 |
Inj triferic avnu 0.1mg iron |
|
J1452 |
Intraocular fomivirsen na |
|
J1457 |
Gallium nitrate injection |
|
J1562 |
Vivaglobin, inj |
|
J1572 |
Flebogamma injection |
|
J1620 |
Gonadorelin hydroch/ 100 mcg |
|
J1655 |
Tinzaparin sodium injection |
|
J1710 |
Hydrocortisone sodium ph inj |
|
J1810 |
Droperidol/fentanyl inj |
|
J1890 |
Cephalothin sodium injection |
|
J1940 |
Furosemide injection |
|
J1945 |
Lepirudin |
|
J2150 |
Mannitol injection |
|
J2310 |
Inj naloxone hydrochloride |
|
J2311 |
Inj, naloxone hcl (zimhi) |
|
J2503 |
Pegaptanib sodium injection |
|
J2504 |
Pegademase bovine, 25 iu |
|
J2513 |
Pentastarch 10% solution |
|
J2910 |
Aurothioglucose injeciton |
|
J2940 |
Somatrem injection |
|
J2995 |
Inj streptokinase /250000 iu |
|
J3280 |
Thiethylperazine maleate inj |
|
J3305 |
Inj trimetrexate glucoronate |
|
J3310 |
Perphenazine injeciton |
|
J3320 |
Spectinomycn di-hcl inj |
|
J3355 |
Urofollitropin, 75 iu |
|
J3364 |
Urokinase 5000 iu injection |
|
J3365 |
Urokinase 250,000 iu inj |
|
J3370 |
Vancomycin hcl injection |
|
J3371 |
Inj, vancomycin hcl (mylan) |
|
J3372 |
Inj, vancomycin hcl (xellia) |
|
J3400 |
Triflupromazine hcl inj |
|
J7309 |
Methyl aminolevulinate, top |
|
J7310 |
Ganciclovir long act implant |
|
J7505 |
Monoclonal antibodies |
|
J7513 |
Daclizumab, parenteral |
|
J8562 |
Oral fludarabine phosphate |
|
J8650 |
Nabilone oral |
|
J9019 |
Erwinaze injection |
|
J9020 |
Asparaginase, nos |
|
J9037 |
Inj belantamab mafodot blmf |
|
J9098 |
Cytarabine liposome inj |
|
J9151 |
Daunorubicin citrate inj |
|
J9165 |
Diethylstilbestrol injection |
|
J9212 |
Interferon alfacon-1 inj |
|
J9247 |
Inj, melphalan flufenami 1mg |
|
J9270 |
Plicamycin (mithramycin) inj |
|
J9340 |
Thiotepa injection |
|
M0220 |
Tixagev and cilgav inj |
|
M0221 |
Tixagev and cilgav inj hm |
|
M0222 |
Bebtelovimab injection |
|
M0223 |
Bebtelovimab injection home |
|
M0240 |
Casiri and imdev repeat |
|
M0241 |
Casiri and imdev repeat hm |
|
M0243 |
Casirivi and imdevi inj |
|
M0244 |
Casirivi and imdevi inj hm |
|
M0245 |
Bamlan and etesev infusion |
|
M0246 |
Bamlan and etesev infus home |
|
M0247 |
Sotrovimab infusion |
|
M0248 |
Sotrovimab inf, home admin |
|
Q0174 |
Thiethylperazine maleate10mg |
|
Q0220 |
Tixagev and cilgav, 300mg |
|
Q0221 |
Tixagev and cilgav, 600mg |
|
Q0222 |
Bebtelovimab 175 mg |
|
Q0240 |
Casirivi and imdevi 600 mg |
|
Q0243 |
Casirivimab and imdevimab |
|
Q0244 |
Casirivi and imdevi 1200 mg |
|
Q0245 |
Bamlanivimab and etesevima |
|
Q0247 |
Sotrovimab |
|
Q2017 |
Teniposide, 50 mg |
|
Q4100 |
Skin substitute, nos |
|
Q4106 |
Dermagraft |
|
Q4231 |
Corplex p, per cc |
|
Q4381 |
Matrix hd derm per sq cm |
|
Q5109 |
Injection, ixifi, 10 mg |
|
Q5139 |
Inj, eculizumab-aeeb, 10 mg |
|
Q9969 |
Non-heu tc-99m add-on/dose |
|
S0013 |
Esketamine, nasal spray |
|
S0017 |
Injection, aminocaproic acid |
|
S0028 |
Injection, famotidine, 20 mg |
|
S0032 |
Injection, nafcillin sodium |
|
S0039 |
Injection, sulfamethoxazole |
|
S0074 |
Injection, cefotetan disodiu |
|
S0080 |
Injection, pentamidine iseth |
|
S0189 |
Testosterone pellet 75 mg |
|
S4988 |
Penile contractur devic manu |
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