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CA Physician Fee Schedule Update Adds New Billing Codes, NCCI Edits

April 4, 2018 by Catherine Montgomery

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:

  • The adoption of Medicare’s National Physician Fee Schedule Relative Value File RVU18B April 1, 2018 quarterly update. The new RVU18B includes includes 16  new billing codes, Healthcare Common Procedure Coding System (HCPCS), as follows:

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

  • The adoption of Medicare’s quarterly update to the Practitioner Procedure-to-Procedure (PTP) NCCI Edits which includes 187 changes in total. The Center for Medicare and Medicaid Services (CMS) website lists the new NCCI Edits. The DWC order, accessible on the DWC website, links to the relevant CMS pages.
  • The adoption of Medicare’s NCCI Medically Unlikely Edits (MUE) April 1, 2018 quarterly update for Practitioner services with 91 new edits and the deletion of  8 previous edits.

    The Practitioner services
    MUE table is available on the CMS website, and the DWC plans to post the table on its website’s DWC Physician Fee Schedule page.

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.


Our Work Comp Wizard includes our OMFS Calculator, which easily calculates reimbursements for workers’ comp services. Enjoy a free trial of the Work Comp Wizard, and see what DaisyBill can do for your office.

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