California providers and staff, here’s an urgent Friday Task: Prepare for increased reimbursements for workers’ compensation physician services.

Effective for dates of service starting tomorrow, February 1, California’s Division of Workers’ Compensation (CA DWC) issued an update raising reimbursements for the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS).

The CA DWC increased the Conversion Factor that determines physician reimbursement rates by 0.58%, from $48.51 to $48.79. Starting tomorrow, that translates to workers’ comp physician reimbursements at 150.84% of the Medicare rates for the same services.

Remember: Claims administrators may not update their systems to reimburse your practice accurately according to the current rates.

We strongly advise non-daisyBill providers to adjust their systems and begin billing at the new rates for service dates starting February 1. Use daisyWizard to determine the updated reimbursement rates.

Good news for daisyBillers: Our billing software will automatically reflect the latest rates; enjoy your Friday.

CA OMFS Update: February 2025

As a reminder, the CA DWC released an update order and Newsline announcing the OMFS update in December 2024. The update includes:

1. Increasing the Conversion Factor for calculating physician reimbursement rates to $48.79
2. Higher reimbursements for California-Specific ‘WC’ Codes
3. New reimbursement calculations for 16 procedure codes
4. 318 new procedure codes
5. 128 deleted procedure codes

Starting for all dates of service on or after February 1st, our billing software will automatically apply the appropriate charges for all billing codes to daisyBillers.

For non-daisyBill providers, updating your billing systems to reflect these changes is essential. As we’ve seen repeatedly, providers cannot rely on claims administrators to pay increased rates out of a sense of civic duty.

Instant Fee Schedule Calculations

The easiest way to bill according to the correct fee schedule rates for the date of service—with complete confidence in the accuracy of your calculations—is to use daisyWizard’s Fee Schedule Calculator.

See the screenshot below. In this example, for a February 1, 2025, date of service, the provider bills for:

• Evaluation and Management code CPT 99214
• California-specific code WC002 for the Physician’s Progress Report (PR-2)

The Wizard calculates that under the OMFS rates effective February 1, for a physician in Los Angeles County (remember—location affects reimbursement rates), CPT 99214 pays $207.52, and WC002 pays $15.72.

If you (or the claims administrator) doubt whether the rates above are correct, see the screenshot below which provides calculation details.

The Fee Schedule Calculator offers the correct reimbursement amounts and generates an in-depth summary that includes every detail of the calculation formula, from the Conversion Factor to Geographic Practice Cost Indices (per the Place of Service County) and more.

Below are the calculation details for CPT 99214.

The same goes for WC002, though the calculations are considerably less complex for California-specific codes.

These calculations are ironclad (provider lien representatives have presented daisyWizard calculations to the Workers’ Compensation Appeals Board (WCAB) in reimbursement disputes). By “showing the work,” the Fee Schedule Calculator leaves no doubt as to the reimbursements the OMFS dictates.

daisyBill experts are here to answer any questions providers have about fee schedule calculations, regardless of whether you are a client. Reach out if you need to, and bill beautifully in 2025.

Get instant, accurate fee schedule calculations. Try our Fee Schedule Calculator free for 3 days.

TRY THE CALCULATOR