In Newsline No.: 2019-46, the California Division of Workers’ Comp (DWC) announced changes to the Official Medical Fee Schedule for Physician Services / Non-Physician Practitioner Services.
Effective July 1, 2019 the DWC adopted the National Correct Coding Initiative Medically Unlikely Edits July 1, 2019 quarterly update (excluding MUE “0” value codes).
The MUE file sets forth the maximum number of units related to a specific procedure that is medically likely to be reported by a treating physician.
For more information on how MUEs impact reimbursements read: A Guide to Medically Unlikely Edits for Workers’ Comp Bills
The table below summarizes the changes to MUEs effective for all dates of service on or after July 1, 2019.
HCPCS |
Units of Service: April 2019 |
Units of Service: July 2019 |
Unit Change |
J7513 |
6 |
0 |
-6 |
J9355 |
100 |
105 |
5 |
G0421 |
4 |
2 |
-2 |
97537 |
8 |
6 |
-2 |
88185 |
34 |
35 |
1 |
92621 |
4 |
2 |
-2 |
87481 |
2 |
5 |
3 |
87230 |
3 |
2 |
-1 |
87106 |
4 |
3 |
-1 |
87101 |
4 |
2 |
-2 |
87088 |
6 |
3 |
-3 |
87081 |
6 |
2 |
-4 |
87077 |
10 |
4 |
-6 |
87076 |
6 |
2 |
-4 |
87073 |
3 |
2 |
-1 |
87071 |
4 |
2 |
-2 |
87015 |
4 |
3 |
-1 |
85397 |
3 |
2 |
-1 |
85347 |
5 |
3 |
-2 |
83883 |
6 |
4 |
-2 |
82657 |
3 |
2 |
-1 |
82172 |
3 |
2 |
-1 |
76828 |
3 |
2 |
-1 |
76827 |
3 |
2 |
-1 |
76826 |
3 |
2 |
-1 |
76825 |
3 |
2 |
-1 |
76821 |
3 |
2 |
-1 |
76819 |
3 |
2 |
-1 |
76818 |
3 |
2 |
-1 |
76816 |
3 |
2 |
-1 |
73620 |
3 |
2 |
-1 |
73600 |
3 |
2 |
-1 |
73562 |
4 |
3 |
-1 |
73120 |
3 |
2 |
-1 |
72275 |
3 |
1 |
-2 |
63088 |
4 |
3 |
-1 |
57100 |
3 |
2 |
-1 |
47010 |
3 |
1 |
-2 |
44615 |
4 |
3 |
-1 |
44121 |
4 |
2 |
-2 |
41105 |
3 |
2 |
-1 |
41100 |
3 |
2 |
-1 |
40812 |
4 |
2 |
-2 |
40810 |
4 |
2 |
-2 |
40808 |
4 |
2 |
-2 |
38505 |
3 |
2 |
-1 |
42104 |
3 |
2 |
-1 |
42100 |
3 |
2 |
-1 |
28740 |
4 |
2 |
-2 |
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