CA Fee Schedule Update: Physician Services (Q3 2026)

July 7, 2026 7 min read

The California Division of Workers’ Compensation (CA DWC) issued a third-quarter update to the Physician and Non-Physician Practitioner Fee Schedule for workers’ compensation.

The changes are effective for all dates of service on or after July 1, 2026. The update adds reimbursement for 79 Healthcare Common Procedure Coding System (HCPCS) codes and changes the reimbursement calculations for 30 other HCPCS codes.

The update aligns the Physician Fee Schedule with changes to the Medicare payment system, as required by California Labor Code Section 5307.1. The CA DWC announced the update in a Newsline, and posted the adoption order on its website.

daisyBIll clients do not need to take any action. Our billing software and Fee Schedule Calculator automatically incorporate the changes for all dates of service on or after July 1. We advise non-daisyBill providers to adjust their systems appropriately.

Read on for details!

Reimbursement Added for 79 HCPCS Codes

In the table below, each HCPCS code has a ‘Base Maximum Fee Reimbursement Calculation’ that indicates how to correctly calculate the reimbursement rate for the newly payable HCPCS codes.

For all 79 HCPCS codes, reimbursement is determined “By Report.” The reimbursement rate for “By Report” codes is determined by identifying a comparable procedure in terms of the time, skill, and resources required and charging accordingly, per the instructions in California Code of Regulations (CCR) Section 9789.12.4.

HCPCS	Modifier	Description	Base Maximum Fee Reimbursement Calculation
90616		Tirv vacc mrna 37.5/0.38 im	By Report
90639		Vacc qirv mrna 50mcg/.5ml im	By Report
1026T		Trvg lsr photobiom ther plvs	By Report
1027T		Prq ins/rplc nstm cth vnt pt	By Report
1028T		Map&prgr nstm cth vent repos	By Report
1029T		Map&prg nstm cth vnt wo rpos	By Report
1030T		Crtj dig 3d mdl surf mesh 1	By Report
1031T		Crtj dig 3d mdl surf mesh ea	By Report
1032T		Crtj dig 3d mdl mesh&sim 1	By Report
1033T		Crtj dig 3d mdl mesh&sim ea	By Report
1034T		Crt dig 3d mdl msh sim&aly 1	By Report
1035T		Crt dig 3dmdl msh sim&aly ea	By Report
1036T		N-invas hemodyn asmt plm prs	By Report
1036T	26	N-invas hemodyn asmt plm prs	By Report
1036T	TC	N-invas hemodyn asmt plm prs	By Report
1037T		Histotripsy mal pncrtc tiss	By Report
1038T		Autol musc cll ther njx tong	By Report
1039T		Connectomic alys prv brn mri	By Report
1039T	26	Connectomic alys prv brn mri	By Report
1039T	TC	Connectomic alys prv brn mri	By Report
1040T		Brnchsc flx brncl crtx 1 lng	By Report
1041T		Augmnt alg alys enceph wvfrm	By Report
1041T	26	Augmnt alg alys enceph wvfrm	By Report
1041T	TC	Augmnt alg alys enceph wvfrm	By Report
1042T		Impl absrb uro scaff prstatc	By Report
1043T		Quan mr alys liver tiss 1/+	By Report
1043T	26	Quan mr alys liver tiss 1/+	By Report
1043T	TC	Quan mr alys liver tiss 1/+	By Report
1044T		Hrv fth autol htro skn grf 1	By Report
1045T		Hrv fth autl htro skn grf ea	By Report
1046T		Autol htro grf appl t/a/l 1	By Report
1047T		Autol htro grf appl t/a/l ea	By Report
1048T		Autol htro grf appl f-dgt 1	By Report
1049T		Autol htro grf appl f-dgt ea	By Report
1050T		Ins subq hrt fail dcomp mntr	By Report
1051T		Rmv subq hrt fail dcomp mntr	By Report
1052T		Interg sbq hrt fail dcm mntr	By Report
1052T	26	Interg sbq hrt fail dcm mntr	By Report
1052T	TC	Interg sbq hrt fail dcm mntr	By Report
1053T		Prgrmg sbq hrt fail dcm mntr	By Report
1053T	26	Prgrmg sbq hrt fail dcm mntr	By Report
1053T	TC	Prgrmg sbq hrt fail dcm mntr	By Report
A9574		Inj. ferumoxytol, 1 mg	By Report
G0574		Mgt new pt dem res care cmmi	By Report
G0575		Mgt est pt dem res care cmmi	By Report
G0577		Vasc emb/occl organ, pgc	By Report
G0669		Eckm oap-initial period	By Report
G0670		Eckm oap-follow-on period(s)	By Report
G0671		Ckm oap-initial period	By Report
G0672		Ckm oap-follow-on period(s)	By Report
G0673		Msk oap-initial period	By Report
G0674		Bh oap-initial period	By Report
G0675		Bh oap-follow-on period(s)	By Report
G0676		Std co-mgmt-eckm, ckm	By Report
G0677		Std co-mgmt-msk	By Report
G0678		Std co-mgmt-bh	By Report
J0528		Inj fosfomycin disodium 20mg	By Report
J1289		Narsoplimab-wuug, 1 mg	By Report
J1577		Inj, qivigy, 100mg	By Report
J2361		Inj depemokimab-ulaa 1 mg	By Report
J2374		Apraclonidine hcl opht 0.1ml	By Report
J2789		Riboflavin epioxa/hd<=2ml	By Report
J3386		Etuvetidigene autotemecel	By Report
J3405		Inj onase abepar-brve treat	By Report
J7176		Inj. fesilty, 1 mg	By Report
J9053		Inj belantamab mafodot blmf	By Report
J9062		Inj amivantamab 5mg hyaluron	By Report
J9232		Inj docetaxel (hospira) 1 mg	By Report
M0231		Inf tocilizumab-bavi 1st dos	By Report
M0232		Inf tocilizumab-bavi 2nd dos	By Report
Q0234		Inj, tocilizumab-bavi, 1mg	By Report
Q5164		Ustekinumab-hmny, 1 mg	By Report
Q5165		Inj, denosumab-mobz, 1 mg	By Report
Q5166		Inj, denosumab-desu, 1 mg	By Report
Q5167		Inj, denosumab-qbde, 1 mg	By Report
Q5168		Inj. nufymco, 0.1 mg	By Report
Q5169		Inj, armlupeg, 0.5 mg	By Report
Q5170		Inj, aflibercept-boav, 1 mg	By Report
Q5171		Inj, den (boncres), bio, 1mg	By Report

Reimbursement Calculation Changes for 30 Codes

For dates of service on or after July 1, the method for calculating reimbursement rates changes for 30 HCPCS billing codes. However, the change is only fee-affecting for one code among those 30:

Reimbursement for HCPCS A4100 is determined “By Report.” As noted above, reimbursement rates for “By Report” codes are determined by identifying a comparable procedure in terms of the time, skill, and resources required and charging accordingly. Complete “By Report” billing instructions are available in California Code of Regulations Section 9789.12.4.
29 HCPCS codes have a new “Status Indicator” that is not fee-affecting. Medicare assigns all HCPCS codes a Status Indicator code (e.g., ‘E,’ ‘C’), which is used to determine reimbursement status. The Status Indicator changes for 29 HCPCS codes for dates of service on or after July 1. However, the status code changes will not impact the final reimbursement amounts.

Details of the reimbursement calculations for each of the 30 affected codes are shown in the table below. The table lists:

The HCPCS code affected by the CA DWC 2026 Physician and Non-Physician Fee Schedule update
The method for calculating reimbursement for dates of service prior to July 1, 2026
The method for calculating reimbursement, effective July 1, 2026
The Status Code for dates of service prior to July 1, 2026
The Status Code, effective July 1, 2026
Whether or not the change is “Fee-Affecting,” i.e., whether the reimbursement amount changes

HCPCS	Description	Reimbursement Calculation: Dates of Service Prior to July 1, 2026	Reimbursement Calculation: Dates of Service On or After July 1, 2026	Status Code: Dates of Service Prior to July 1, 2026	Status Code: Dates of Service On or After July 1, 2026	Fee-Affecting Change?
A4100	Nosht skin sub fda clrd nos	RVU+GPCI+CF	By Report	A	C	Yes
Q4112	Cymetra injectable	By Report	By Report	E	C	No
Q4113	Graftjacket xpress	By Report	By Report	E	C	No
Q4114	Integra flowable wound matri	By Report	By Report	E	C	No
Q4118	Matristem micromatrix	By Report	By Report	E	C	No
Q4139	Amnio or biodmatrix, inj 1cc	By Report	By Report	E	C	No
Q4145	Epifix, inj, 1mg	By Report	By Report	E	C	No
Q4149	Excellagen, 0.1 cc	By Report	By Report	E	C	No
Q4155	Neoxflo or clarixflo 1 mg	By Report	By Report	E	C	No
Q4162	Wndex flw, bioskn flw, 0.5cc	By Report	By Report	E	C	No
Q4168	Amnioband, 1 mg	By Report	By Report	E	C	No
Q4171	Interfyl, 1 mg	By Report	By Report	E	C	No
Q4174	Palingen or promatrx	By Report	By Report	E	C	No
Q4177	Floweramnioflo, 0.1 cc	By Report	By Report	E	C	No
Q4185	Cellesta flowab amnion 0.5cc	By Report	By Report	E	C	No
Q4189	Artacent ac, 1 mg	By Report	By Report	E	C	No
Q4192	Restorigin, 1 cc	By Report	By Report	E	C	No
Q4202	Keroxx (2.5g/cc), 1cc	By Report	By Report	E	C	No
Q4206	Fluid flow or fluid gf 1 cc	By Report	By Report	E	C	No
Q4212	Allogen, per cc	By Report	By Report	E	C	No
Q4213	Ascent, 0.5 mg	By Report	By Report	E	C	No
Q4215	Axolotl ambient, cryo 0.1 mg	By Report	By Report	E	C	No
Q4230	Cogenex flow amnion 0.5 cc	By Report	By Report	E	C	No
Q4233	Surfactor /nudyn per 0.5 cc	By Report	By Report	E	C	No
Q4240	Corecyte topical only 0.5 cc	By Report	By Report	E	C	No
Q4241	Polycyte, topical only 0.5cc	By Report	By Report	E	C	No
Q4242	Amniocyte plus, per 0.5 cc	By Report	By Report	E	C	No
Q4245	Amniotext, per cc	By Report	By Report	E	C	No
Q4246	Coretext or protext, per cc	By Report	By Report	E	C	No
Q4310	Procenta, per 100 mg	By Report	By Report	E	C	No

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.

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