CA OMFS Update: Physician Services (Q2 2025)

April 8, 2025 4 min read

By: the daisyNews Team

CA OMFS Update: Physician Services (Q2 2025)

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

The changes are effective for all dates of service on or after April 1, 2025. The update:

Adds 61 new procedure codes
Deletes 24 procedure codes
Alters the reimbursement calculation for 1 procedure code

The update conforms the OMFS to relevant 2025 Medicare changes, as California Labor Code Section 5307.1 requires. The DWC announced the update in a recent Newsline, and posted the order adopting the update on the 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 April 1. We advise non-daisyBill providers to adjust their systems appropriately.

Read on for details!

CA Physician Fee Schedule: 61 New HCPCS Codes

Below are the 61 new Healthcare Common Procedure Coding System (HCPCS) codes the CA DWC (and Medicare) adopted for Q2 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
61715	26	Mrgfus strtctc ablt trgt icr	RVU+GPCI+CF
61715	TC	Mrgfus strtctc ablt trgt icr	By Report
A2030		Miro3d fibers, per mg	By Report
A2031		Mirodry, per sq cm	By Report
A2032		Myriad matrix, per sq cm	By Report
A2033		Myriad morcells, 4 mg	By Report
A2034		Found drs solo, per sq cm	By Report
A2035		Corpl p therac p allac p mg	By Report
A6515		Grad com wrap w str fu le cu	By Report
A6516		Grad com wrap w strap foo cu	By Report
A6517		Grad com wrap w strap bn cus	By Report
A6518		Grad com wrap w strap arm cu	By Report
A6519		Grad com garm noc night use	By Report
A6611		Grad com wrap w strap ak cus	By Report
A9154		Artificial saliva, 1 ml	By Report
A9611		Flurpiridaz f18, diag, 1 mci	By Report
G0183		Software meas of cardiac vol	By Report
G0566	26	3d bn img algor drvd fr MRI	By Report
G0566	TC	3d bn img algor drvd fr MRI	By Report
G0566		3d bn img algor drvd fr MRI	By Report
G9919		Scrn nd pos nd prov of rec	By Report
G9920		Scrning perf and negative	By Report
J0281		Inj aminocaproic acid 1 gram	By Report
J1072		Inj, testosterone, azmiro	By Report
J1271		Inj doxycycline hyclate 1 mg	By Report
J1299		Inj, eculizumab, 2 mg	By Report
J1308		Inj, famotidine, 0.25 mg	By Report
J1808		Inj, folic acid, 0.1 mg	By Report
J1938		Inj, furosemide, 1 mg	By Report
J2351		Inj ocrelizumab 1mg hya-ocsq	By Report
J2428		Inj, erzofri, 1 mg	By Report
J2804		Inj, rifampin, 1 mg	By Report
J2865		Inj sulfameth/trim 5 mg/1 mg	By Report
J7521		Tacrolim granules oral susp	By Report
J9024		Inj atezolizumb 5mg hya-tqjs	By Report
J9038		Inj axatilimab-csfr 0.1 mg	By Report
J9054		Inj bortezomib boruzu 0.1 mg	By Report
J9161		Inj denileuk difti-cxdl 1mcg	By Report
Q2057		Afamitresgene autoleucel	By Report
Q4354		Palingen dual-layer sq cm	By Report
Q4355		Abio xpl abio xpl hy p sq cm	By Report
Q4356		Abio mem abio hyd per sq cm	By Report
Q4357		Xwrap plus, per sq cm	By Report
Q4358		Xwrap dual, per sq cm	By Report
Q4359		Choriply, per sq cm	By Report
Q4360		Amchoplast fd per sq cm	By Report
Q4361		Epixpress, per sq cm	By Report
Q4362		Cygnus disk, per sq cm	By Report
Q4363		Am bur mem hydro per sq cm	By Report
Q4364		Am bur xp mem xpl hy p sq cm	By Report
Q4365		Amnio bur dl mem per sq cm	By Report
Q4366		Dl amnio bur x-mem per sq cm	By Report
Q4367		Amniocore sl, per sq cm	By Report
Q5147		Inj, aflibercept-ayyh, 1 mg	By Report
Q5148		Inj, nyposi 1 mcg	By Report
Q5149		Inj, aflibercept-abzv, 1 mg	By Report
Q5150		Inj, aflibercept-mrbb, 1 mg	By Report
Q5151		Inj, eculizumab-aagh, 2 mg	By Report
Q5152		Inj, eculizumab-aeeb, 2 mgá	By Report
Q9999		Inj ustekinumab-aauz 1 mg	By Report
S4024		Air polymer foam per study	By Report

CA Physician Fee Schedule: 24 HCPCS Codes Deleted

For dates of service on or after April 1, 2025, the HCPCS codes below are not applicable under the California Physician Fee Schedule.

HCPCS	Description
G1001	Cdsm evicore
G1002	Cdsm medcurrent
G1003	Cdsm medicalis
G1004	Cdsm ndsc
G1007	Cdsm aim
G1008	Cdsm cranberry pk
G1010	Cdsm stanson
G1011	Cdsm qualified nos
G1012	Cdsm agilemd
G1013	Cdsm evidencecare
G1014	Cdsm inveniqa
G1015	Cdsm reliant
G1016	Cdsm speed of care
G1017	Cdsm healthhelp
G1018	Cdsm infinx
G1019	Cdsm logicnets
G1020	Cdsm curbside
G1021	Cdsm ehealthline
G1022	Cdsm intermountain
G1023	Cdsm persivia
G1024	Cdsm radrite
M1389	Pt rsn no exm
U0001	2019-ncov diagnostic p
U0002	Covid-19 lab test non-cdc

1 HCPCS Reimbursement Calculation Altered

Previously, the OMFS specified the reimbursement calculation for the HCPCS code below. For dates of service on or after April 1, 2025, providers must now bill the code “By Report.”

HCPCS	Description	Reimbursement Calculation
61715	Mrgfus strtctc ablt trgt icr	By Report

Again, 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.

Don’t sweat the updates—let daisyBill make billing a breeze. Click below to see how it works.

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