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 |
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