CA OMFS Update: Physician Services (Q3 2025)
California’s Division of Workers’ Compensation (CA DWC) issued a third-quarter update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation.
The update adds 106 new Healthcare Common Procedure Coding System (HCPCS) codes, effective for all dates of service on or after July 1, 2025.
The update conforms the OMFS to the relevant 2025 Medicare changes, as California Labor Code Section 5307.1 requires. The CA DWC announced the update in a recent Newsline, and posted the order adopting the update on the CA DWC website.
daisyBIll clients do not need to take any action. Our billing software automatically applies the changes for all dates of service on or after July 1. We advise non-daisyBill providers to adjust their systems appropriately.
Read on for details!
CA Physician Fee Schedule: 106 New HCPCS Codes
Below are the 106 new HCPCS codes the CA DWC (and Medicare) adopted for Q3 2025.
Note that when Medicare does not assign an HCPCS code a Relative Value Unit (RVU), providers calculate the reimbursement “By Report” (BR). California Code of Regulations Section 9789.12.4 provides specific guidelines for calculating BR code reimbursement rates.
HCPCS |
Modifier |
Description |
Reimbursement Calculation |
90382 |
Rsv monoc antb seasn .7ml im |
By Report |
|
90612 |
Inf&sarscov2 vacc 31.7/.32im |
By Report |
|
90613 |
Inf&sarscov2 vacc 40/0.4 im |
By Report |
|
90635 |
H5n1 vacc drv cll cul adj im |
By Report |
|
91323 |
Sarscov2 vac 10 mcg/0.2ml im |
By Report |
|
0948T |
Rem interrog dev ccm phys |
By Report |
|
0949T |
Rem interrog dev ccm tech |
By Report |
|
0950T |
Abltj b9 prst8 tissue hifu |
By Report |
|
0951T |
Tot impl amei 1st plmt |
By Report |
|
0952T |
Tot impl amei rev/rplc mstdc |
By Report |
|
0953T |
Tot impl amei rev/rplc w/o |
By Report |
|
0954T |
Tot impl amei rplc snd proc |
By Report |
|
0955T |
Tot impl amei removal |
By Report |
|
0956T |
Prt crn ch cr&tun elt s-sclp |
By Report |
|
0957T |
Rev s-sclp eltr ra rcvr&tlmt |
By Report |
|
0958T |
Rmv s-sclp eltr ra rcvr&tlmt |
By Report |
|
0959T |
Rmv/rplc magnet coil assem |
By Report |
|
0960T |
Rpl s-sclp eltr ra rcvr&tlmt |
By Report |
|
0961T |
26 |
Shortwave ifr radiation img |
By Report |
0961T |
Shortwave ifr radiation img |
By Report |
|
0961T |
TC |
Shortwave ifr radiation img |
By Report |
0962T |
TC |
Asstv alg alys acous&ecg rec |
By Report |
0962T |
26 |
Asstv alg alys acous&ecg rec |
By Report |
0962T |
Asstv alg alys acous&ecg rec |
By Report |
|
0963T |
Anosc sbmcsl njx bulking agt |
By Report |
|
0964T |
I&cust prep jaw xpnsj 1arch |
By Report |
|
0965T |
I&cst prp jw xpn dl arch non |
By Report |
|
0966T |
I&cst prp jw xpn dl arch fxd |
By Report |
|
0967T |
Tranal ins tmp clrc anst dev |
By Report |
|
0968T |
Insj/rplcmt epcrnl nstim sys |
By Report |
|
0969T |
Removal epicranial nstim sys |
By Report |
|
0970T |
Ablt b9 brst tum perq lsr ea |
By Report |
|
0971T |
Ablt mal brst tum pq lsr uni |
By Report |
|
0972T |
26 |
Asstv alg clsfctn burn hlg |
By Report |
0972T |
Asstv alg clsfctn burn hlg |
By Report |
|
0972T |
TC |
Asstv alg clsfctn burn hlg |
By Report |
0973T |
Slctv nzmtc dbrdmt t/a/l 1st |
By Report |
|
0974T |
Slctv nzmtc dbrdmt t/a/l ea |
By Report |
|
0975T |
Slctv nzmtc dbrdmt s/n/hf 1 |
By Report |
|
0976T |
Slctv nzmtc dbrdmt s/n/hf ea |
By Report |
|
0977T |
26 |
Upr gi bld detcj snr capsule |
By Report |
0977T |
TC |
Upr gi bld detcj snr capsule |
By Report |
0977T |
Upr gi bld detcj snr capsule |
By Report |
|
0978T |
Submucosal cryolysis therapy |
By Report |
|
0979T |
Sbmcsl crylys ther sft palt |
By Report |
|
0980T |
Sbmcsl crylys ther tng&tnsl |
By Report |
|
0981T |
Tcat impl wrls ivc snr |
By Report |
|
0982T |
Rem mntr impl ivc snr set-up |
By Report |
|
0983T |
Rem mntr impl ivc snr phys |
By Report |
|
0984T |
Iv img xtrc cere vsl oct 1st |
By Report |
|
0984T |
TC |
Iv img xtrc cere vsl oct 1st |
By Report |
0984T |
26 |
Iv img xtrc cere vsl oct 1st |
By Report |
0985T |
Iv img xtrc cere vsl oct ea |
By Report |
|
0985T |
26 |
Iv img xtrc cere vsl oct ea |
By Report |
0985T |
TC |
Iv img xtrc cere vsl oct ea |
By Report |
0986T |
TC |
Iv img icr cere vsl oct 1st |
By Report |
0986T |
Iv img icr cere vsl oct 1st |
By Report |
|
0986T |
26 |
Iv img icr cere vsl oct 1st |
By Report |
0987T |
26 |
Iv img icr cere vsl oct ea |
By Report |
0987T |
TC |
Iv img icr cere vsl oct ea |
By Report |
0987T |
Iv img icr cere vsl oct ea |
By Report |
|
G0567 |
Screening hep c detect |
Section 9789.50 establishes payment conditions |
|
J0165 |
Inj epinephrine nos 0.1 mg |
By Report |
|
J0166 |
Inj epinephrine (bpi) |
By Report |
|
J0167 |
Inj epinephrine (hospira) |
By Report |
|
J0168 |
Epinephrine (intl med sys) |
By Report |
|
J0169 |
Inj epinephrine (adrenalin) |
By Report |
|
J0616 |
Inj metoprolol tartrate 1 mg |
By Report |
|
J0618 |
Inj, calcium chloride, 2 mg |
By Report |
|
J1163 |
Inj, diltiazem hcl, 0.5 mg |
By Report |
|
J1326 |
Inj, zolbetuximab-clzb, 2 mg |
By Report |
|
J2312 |
Inj naloxone hcl nos, 0.01mg |
By Report |
|
J2313 |
Inj, naloxone (zimhi) 0.01mg |
By Report |
|
J3373 |
Inj, vancomycin hcl, 10 mg |
By Report |
|
J3374 |
Inj, vancomycin (mylan) 10mg |
By Report |
|
J3375 |
Inj vancomycin (xellia) 10mg |
By Report |
|
J3391 |
Inj, atidarsagene autotemcel |
By Report |
|
J7172 |
Inj marstacim-hncq, 0.5 mg |
By Report |
|
J7356 |
Inj foscarb/foslevodopa 5 mg |
By Report |
|
J9174 |
Inj, docetaxel (beizray) 1mg |
By Report |
|
J9220 |
Indigotindisulfonate sod 1mg |
By Report |
|
J9275 |
Inj cosibelimab-ipdl, 2 mg |
By Report |
|
J9276 |
Inj zanidatamab-hrii, 2 mg |
By Report |
|
J9289 |
Inj nivolumab 2 mg hyaluron |
By Report |
|
J9341 |
Inj thiotepa (tepylute) 1 mg |
By Report |
|
J9342 |
Inj thiotepa nos 1 mg |
By Report |
|
J9382 |
Inj zenocutuzumab-zbco 1 mg |
By Report |
|
Q2058 |
Obecbtge autol up to 400 mil |
By Report |
|
Q4368 |
Amchothick per sq cm |
By Report |
|
Q4369 |
Amnioplast 3 per sq cm |
By Report |
|
Q4370 |
Aeroguard per sq cm |
By Report |
|
Q4371 |
Neoguard per sq cm |
By Report |
|
Q4372 |
Amchoplast excl per sq cm |
By Report |
|
Q4373 |
Membrane wrp lt per sq cm |
By Report |
|
Q4375 |
Duograft ac per sq cm |
By Report |
|
Q4376 |
Duograft aa per sq cm |
By Report |
|
Q4377 |
Trigraft ft per sq cm |
By Report |
|
Q4378 |
Renew ft matrix per sq cm |
By Report |
|
Q4379 |
Amniodefend ft per sq cm |
By Report |
|
Q4380 |
Advograft one per sq cm |
By Report |
|
Q4381 |
Matrix hd derm per sq cm |
By Report |
|
Q4382 |
Advograft dual per sq cm |
By Report |
|
Q5098 |
Inj ustekinumab-srlf, 1 mg |
By Report |
|
Q5099 |
Inj ustekinumab-stba, 1 mg |
By Report |
|
Q5100 |
Inj ustekinumab-kfce, 1 mg |
By Report |
|
Q5153 |
Inj, aflibercept-yszy, 1 mg |
By Report |
Again, all bills providers submit via daisyBill will automatically reflect the most current, accurate fee schedule 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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