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CA OMFS: Physician Fee Schedule Update Effective April 1

CA OMFS: Physician Fee Schedule Update Effective April 1

California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation, effective April 1. The update includes new procedure codes reimbursable by report, as well as updated reimbursements for some existing codes.

Read on for details.

New Procedure Codes

The DWC announced the update in a recent Newsline, and posted the order adopting the update on the Physician and Non-Physician Practitioner Fee Schedule page of the DWC website. The order adds 11 new procedure codes, listed below.

Procedure Code

Description

A9592

Copper cu 64 dotatate diag

G2020

Hi inten serv for SIP model

G2172

Tx for opioid use demo proj

J1427

Inj. viltolarsen

J1554

Inj. asceniv

J7402

Mometasone sinus sinuva

J9037

Inj belantamab mafodont blmf

J9349

Inj., tafasitamab-cxix

Q2053

Brexucabtagene car pos t

S1091

Stent non-coronary propel

All of the above codes are reimbursable by report, meaning the DWC does not assign a payment amount for the procedure. Instead, providers must identify a comparable procedure code, to determine a reasonable payment amount to request from the claims administrator.

In addition, the fee schedule update adds code G2211 for bundled Evaluation and Management (E/M) services.

Increased Reimbursements (Non-Facility)

The update increases reimbursements for three existing procedure codes: CPT G2025, CPT G2082, and CPT G2083. Below, we list the new reimbursement amounts by county, per the application of Geographic Practice Cost Indices (GPCI).

We also list the differences in reimbursement amounts as compared to those for dates of service prior to April 1. The differences are expressed as a percentage. For example, reimbursement for CPT G2025:

  • in Alameda and Contra Costa Counties,
  • On or after April 1, 2021
  • In a non-facility place of service…

...is $153.09, which is 52.17% higher than for dates of service prior to April 1.

Non-Facility Places of Service

The reimbursements below apply when the service is delivered in a non-facility.

County

CPT G2025

On or After 4/1/2021

(% Difference)

CPT G2082

On or After 4/1/2021

(% Difference)

CPT G2083

On or After 4/1/2021

(% Difference)

Alameda and

Contra Costa

$153.09

(52.17%)

$1,502.35

(25.89)

$2,152.20

(26%)

Butte

$134.57

(47.56%)

$1,209.71

(25.76)

$1,730.47

(25.92%)

Fresno

$134.57

(47.56%)

$1,209.71

(25.76)

$1,730.47

25.92%)

Imperial

$134.65

(47.52%)

$1,209.75

(25.76)

$1,730.51

(25.91%)

Kern

$135.58

(47.20%)

$1,210.21

(25.75)

$1,730.97

(25.91%)

Kings

$134.57

(47.56%)

$1,209.71

(25.76)

$1,730.47

(25.92%)

Los Angeles

$143.30

(49.27%)

$1,332.15

(25.81)

$1,906.69

(25.95%)

Madera

$134.57

(47.56%)

$1,209.71

(25.76)

$1,730.47

(25.92%)

Marin

$151.83

(51.89%)

$1,482.40

(25.88)

$2,123.45

(26%)

Merced

$134.57

(47.56%)

$1,209.71

(25.76)

$1,730.47

(25.92%)

Monterey

$140.04

(48.14%)

$1,273.61

(25.78)

$1,822.24

(25.93%)

Napa

$144.58

(50.71%)

$1,381.10

(25.85)

$1,977.65

(25.98%)

Orange

$143.30

(49.27%)

$1,332.15

(25.81)

$1,906.69

(25.95%)

Sacramento, Placer,

Yolo, El Dorado

$136.00

(47.68%)

$1,225.45

(25.77%)

$1,753.05

(25.92%)

San Benito

$154.25

(51.81%)

$1,504.00

(25.88%)

$2,154.34

(26%)

San Bernardino,

Riverside

$135.94

(47.08%)

$1,210.39

(25.75%)

$1,731.15

(25.91%)

San Diego

$139.99

(49.15%)

$1,298.30

(25.81%)

$1,858.17

(25.95%)

San Francisco

$153.09

(52.17%)

$1,502.35

(25.89%)

$2,152.20

(26%)

San Joaquin

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

San Luis Obispo

$135.77

(48.02%)

$1,231.78

(25.78%)

$1,762.32

(25.92%)

San Mateo

$153.09

(52.17%)

$1,502.35

(25.89%)

$2,152.20

(26%)

Santa Barbara

$140.82

(49.37%)

$1,311.60

(25.82%)

$1,877.34

(25.95%)

Santa Clara

$157.39

(52.80%)

$1,562.46

(25.9%)

$2,238.71

(26.01%)

Santa Cruz

$142.53

(49.79%)

$1,338.21

(25.83%)

$1,915.69

(25.96%)

Shasta

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

Solano

$144.58

(50.71%)

$1,381.10

(25.85%)

$1,977.65

(25.98%)

Sonoma

$141.20

(49.32%)

$1,313.93

(25.81%)

$1,880.65

(25.95%)

Stanislaus

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

Sutter, Yuba

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

Tulare

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

Ventura

$142.01

(49.89%)

$1,335.82

(25.83%)

$1,912.32

(25.96%)

All Other Counties

$134.57

(47.56%)

$1,209.71

(25.76%)

$1,730.47

(25.92%)

Facility Places of Service

The reimbursements below apply when the service is delivered in a facility.

County

CPT G2025

On or After 4/1/2021

(% Difference)

CPT G2082

On or After 4/1/2021

(% Difference)

CPT G2083

On or After 4/1/2021

(% Difference)

Alameda and

Contra Costa

$153.09

(52.17%)

$52.09

(11.71%)

$52.09

(11.71%)

Butte

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Fresno

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Imperial

$134.65

(47.52%)

$47.57

(10.26%)

$47.57

(10.26%)

Kern

$135.58

(47.20%)

$48.03

(10.16%)

$48.03

(10.16%)

Kings

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Los Angeles

$143.30

(49.27%)

$49.93

(10.8%)

$49.93

(10.8%)

Madera

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Marin

$151.83

(51.89%)

$51.78

(11.63%)

$51.78

(11.63%)

Merced

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Monterey

$140.04

(48.14%)

$49.23

(10.46%)

$49.23

(10.46%)

Napa

$144.58

(50.71%)

$49.78

(11.23%)

$49.78

(11.23%)

Orange

$143.30

(49.27%)

$49.93

(10.8%)

$49.93

(10.8%)

Sacramento, Placer,

Yolo, El Dorado

$136.00

(47.68%)

$47.99

(10.31%)

$47.99

(10.31%)

San Benito

$154.25

(51.81%)

$52.64

(11.59%)

$52.64

(11.59%)

San Bernardino,

Riverside

$135.94

(47.08%)

$48.22

(10.14%)

$48.22

(10.14%)

San Diego

$139.99

(49.15%)

$48.82

(10.75%)

$48.82

(10.75%)

San Francisco

$153.09

(52.17%)

$52.09

(11.71%)

$52.09

(11.71%)

San Joaquin

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

San Luis Obispo

$135.77

(48.02%)

$47.78

(10.42%)

$47.78

(10.42%)

San Mateo

$153.09

(52.17%)

$52.09

(11.71%)

$52.09

(11.71%)

Santa Barbara

$140.82

(49.37%)

$49.02

(10.81%)

$49.02

(10.81%)

Santa Clara

$157.39

(52.80%)

$53.26

(11.9%)

$53.26

(11.9%)

Santa Cruz

$142.53

(49.79%)

$49.45

(10.96%)

$49.45

(10.96%)

Shasta

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Solano

$144.58

(50.71%)

$49.78

(11.23%)

$49.78

(11.23%)

Sonoma

$141.20

(49.32%)

$49.18

(10.82%)

$49.18

(10.82%)

Stanislaus

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Sutter, Yuba

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Tulare

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

Ventura

$142.01

(49.89%)

$49.24

(10.99%)

$49.24

(10.99%)

All Other Counties

$134.57

(47.56%)

$47.53

(10.29%)

$47.53

(10.29%)

As always, we’ll keep our readers updated regarding updates to the OMFS. Subscribe below for the latest information.


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