On April 13, 2020, the California Division of Workers’ Compensation (DWC) issued a Newsline adopting changes to telehealth regulations effective for all dates of service on or after 4/15/2020. At the end of this blog post is a short recording that explains these most recent important DWC changes.

Edit 5/14/2020: On 5/7/2020 the California Division of Workers’ Comp Administrative Director, George P. Parisotto, issued a new Order retroactively changing the reimbursement calculation for telehealth services. Some of the information on this page may not be correct, depending on the date of service. For the latest reimbursement rules, consult the latest Administrative Orders here and check our dedicated COVID-19 page for updates.

The recent DWC Newsline and the accompanying Order of the Administrative Director explain three new and important changes to the telehealth regulations. With a single exception, these changes align California workers’ compensation telehealth rules with Medicare telehealth rules.

Effective 4/15/2020, the DWC adjusted its telehealth regulations with the adoption of the following adjustments:

1. Workers comp providers may only furnish telehealth medical treatment that is listed on the Medicare List of Telehealth Services.
2. During the Public Health Emergency, for telehealth services, bills should list the same Place of Service that would have been used had the provider furnished the medical service in-person.
3. A modifier 95 is required when providers furnish medical services via telehealth.

It is important to note that the DWC did not adopt the Medicare list of eligible distant providers. While Medicare restricts telehealth eligibility to only certain types of providers, the DWC is not imposing equivalent eligibility criteria. The DWC’s more expansive approach “encourages all parties to consider creative solutions appropriate to providing care to injured workers” during the COVID emergency.

Telehealth Workers’ Comp Reimbursement Ramifications

When a provider furnishes a telehealth service to an injured worker, as long as the medical treatment is listed on the Medicare List of Telehealth Services, the provider’s reimbursement is equivalent to the reimbursement the provider would have received for delivering the medical service in-person. For all telehealth services furnished on or after 4/15/2020, workers’ compensation providers in California are no longer penalized with lower facility reimbursements.

To help better understand these changes by the DWC, watch the following short “mini webby” which addresses each of the three changes noted above in more detail.

For more on telehealth rules for Medicare, California health insurers, and California workers’ compensation, look through the free resources available on our COVID-10 page.

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