A new order from the Administrative Director of California’s Division of Workers’ Compensation (DWC) updates the Physician and Non-physician practitioner services portion of the Official Medical Fee Schedule (OMFS).
The changes, effective April 1, 2018, include the addition of 16 new billing codes, as well as over 200 new National Correct Coding Initiative (NCCI) edits.
The DWC announced the order in a recent Newsline. To conform the OMFS to Medicare’s April fee schedule release and quarterly updates, the Division announced several changes, incorporating the changes into California Code of Regulations (CCR) Section 9789.19. These changes include:
HCPCS |
Status Indicator |
Service Description |
OMFS Reimbursement |
J0565 |
E |
Inj, bezlotoxumab, 10 mg |
$38.00 |
J0604 |
E |
Cinacalcet, esrd on dialysis |
$0.87 |
J0606 |
E |
Inj, etelcalcetide, 0.1 mg |
$3.27 |
J1428 |
E |
Inj, eteplirsen, 10 mg |
$160.00 |
J1555 |
E |
Inj cuvitru, 100 mg |
$16.80 |
J1627 |
E |
Inj, granisetron, xr, 0.1 mg |
$5.07 |
J1726 |
E |
Makena, 10 mg |
$3.06 |
J1729 |
E |
Inj hydroxyprogst capoat nos |
$13.64 |
J2326 |
E |
Inj, nusinersen, 0.1mg |
$1042.50 |
J2350 |
E |
Injection, ocrelizumab, 1 mg |
$54.11 |
J3358 |
E |
Ustekinumab, iv inject, 1 mg |
$12.31 |
J7345 |
E |
Aminolevulinic acid, 10% gel |
$9.04 |
J9022 |
E |
Inj, atezolizumab,10 mg |
$71.85 |
J9023 |
E |
Injection, avelumab, 10 mg |
$76.33 |
J9203 |
E |
Gemtuzumab ozogamicin 0.1 mg |
$182.04 |
J9285 |
E |
Inj, olaratumab, 10 mg |
$47.20 |
We’ll keep readers updated on any further OMFS changes, and — as always — DaisyBill clients can rest assured that we incorporate the latest changes into our OMFS Calculator.
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