California-Specific Codes - 2020 Reimbursement Updates

Attention California providers -- in 2020 reimbursements increased for all California-specific workers’ comp codes!

In the Physician Fee Schedule, these state-specific codes cover services for which there are no appropriate CPT Codes, such as the Primary Treating Physician’s Progress Report (DWC Form PR-2). Annually, California’s Division of Workers’ Compensation (DWC) establishes a single new statewide reimbursement for each of the services covered by these ‘WC’ codes. For reference, these codes are authorized by California Code of Regulations §9789.12.14.

Below, we’ve put together a helpful table to understand the eleven California-specific codes.

California-Specific Codes NOT Affected by GPCIs

Fortunately, the reimbursement formula for California-specific codes is straightforward and not subject to variation by locality. In other words, these codes are not affected by Geographic Practice Cost Index (GPCI) changes to the reimbursement calculation for other services.

California-specific codes are reimbursed the same throughout California and payment for these services must conform to the plain language of the fee schedule.

2020 Reimbursements for California-Specific Codes

The following table illustrates the new reimbursement for these California-specific codes, effective for all dates of service on or after January 1, 2020. The table also compares the new reimbursement to the previous 2019 reimbursement. All the rates received a modest, but welcome, increase.

California - Specific Code

Description

Reimbursement Effective 1/1/2019

Reimbursement Effective 1/1/2020

Percent Change

WC001

Doctor’s First Report of Occupational Illness or Injury (Form 5021)

$0.00

$0.00

N/A

WC002

Primary Treating Physician’s Progress Report (Form PR-2)

$12.65

$12.89

+1.90%

WC003

Primary Treating Physician’s Permanent & Stationary Report (Form PR-3): First page

$41.06

$41.84

+1.90%

Primary Treating Physician’s Permanent & Stationary Report (Form PR-3): Each additional page. Maximum of six pages, absent mutual agreement

$25.25

$25.73

+1.90%

WC004

Primary Treating Physician’s Permanent & Stationary Report (Form PR-4): First page

$41.06

$41.84

+1.90%

Primary Treating Physician’s Permanent & Stationary Report (Form PR-4): Each additional page. Maximum of seven pages, absent mutual agreement

$25.25

$25.73

+1.90%

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: First page

$41.06

$41.84

+1.90%

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report: Each additional page. Maximum of six pages absent mutual agreement

$25.25

$25.73

+1.90%

WC007

Consultation Reports requested by the WCAB or the Administrative Director: First page

$41.06

$41.84

+1.90%

Consultation Reports requested by the WCAB or the Administrative Director: Each additional page. Maximum of six pages absent mutual agreement

$25.25

$25.73

+1.90%

WC008

Chart Notes: Up to the first 15 pages.

$10.89

$11.10

+1.93%

Chart Notes: Each additional page after the first 15 pages

$0.25

$0.25

N/A

WC009

Duplicate Reports: Up to the first 15 pages.

$10.89

11.10

+1.93%

Duplicate Reports: Each additional page after the first 15 pages

$0.25

$0.25

N/A

WC010

Duplication of X-Ray

$5.44

$5.54

+1.84%

WC011

Duplication of Scan

$10.89

$11.10

+1.93%

WC012

Missed Appointments. This code is designated for communication only. It does not imply that compensation is owed. Non-reimbursable absent agreement.

$0.00

$0.00

N/A


Join us for the second installment of our popular 2020 California OMFS Webinar series! This will include updates to the ASC and Pathology/Clinical Lab fee schedules, and a continuation of our summary of changes to the Physician fee schedule, including a recently announced retroactive correction.

SAVE MY SEAT

intercom_chat_bubble_icon