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CA Physician MUE Reimbursement Change as of 7/1/2019

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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