The California Division of Workers’ Compensation (CA DWC) issued a second-quarter update to the Physician and Non-Physician Practitioner Fee Schedule for workers’ compensation.

The changes are effective for all dates of service on or after April 1, 2026. The update adds reimbursement for 51 Healthcare Common Procedure Coding System (HCPCS) 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.

daisyBIll clients do not need to take any action. Our billing software and Fee Schedule Calculator will automatically incorporate the changes for all dates of service on or after April 1. We advise non-daisyBill providers to adjust their systems appropriately.

Read on for details!

51 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 22 HCPCS codes, the reimbursement is calculated using the following factors, expressed in the table as “RVU+GPCI+CF”:

1. The Medicare Relative Value Units (RVUs)
2. The Medicare Geographic Practice Cost Index (GPCI) for the location of service
3. The 2026 California Conversion Factor (CF)

For 26 other HCPCS codes, reimbursement is 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 one HCPCS code, J1572, California Code of Regulations Section 9789.13.2 for Physician-administered drugs, biologicals, vaccines, and blood products establishes reimbursement conditions.

Finally, 2 HCPCS codes (A4318 and A4479) are not separately reimbursable; payment for these codes will be “bundled” with payment for other codes.

All bills providers submit via daisyBill will automatically reflect the most current, accurate reimbursement rates. If you have any questions regarding this update, use the chat function at the bottom right of this screen or email our experts at info@daisybill.com.

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