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California-Specific Codes Updated for 2019

With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR §9789.12.14 by the Division of Workers’ Compensation (DWC) and reimbursement is updated annually. Thankfully, the reimbursement formula is straightforward and not subject to variation by locality.

In the Physician Fee Schedule, the 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, the California DWC establishes a single new statewide reimbursement for each of the services covered by these ‘WC’ codes.

The rates for these codes are not affected by Geographic Practice Cost Index (GPCI) changes to the reimbursement calculation for other services.  Bottom line, these are flat rate fees and payment for these services must conform to the plain language of the fee schedule. Although the reimbursement gain is modest, double check those EORs, as some payers have not been abiding by the current 2019 rates.

The following table illustrates the new reimbursement for these California-specific codes, effective for all dates of service on or after January 1, 2019. The table also compares the new reimbursement to the previous 2018 reimbursement. All the rates received a small, but welcome increase.

California - Specific Code

Description

Reimbursement Effective 1/1/2018

Reimbursement Effective 1/1/2019

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)

$12.46

$12.65

+1.52%

WC003

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

$40.45

$41.06

+1.51%

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

$24.88

$25.25

+1.49%

WC004

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

$40.45

$41.06

+1.51%

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

$24.88

$25.25

+1.49%

WC005

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

$40.45

$41.06

+1.51%

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

$24.88

$25.25

+1.49%

WC007

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

$40.45

$41.06

+1.51%

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

$24.88

$25.25

+1.49%

WC008

Chart Notes: First page

$10.73

$10.89

+1.49%

Chart Notes: Each additional page. Maximum of six pages absent mutual agreement

$0.25

$0.25

N/A

WC009

Duplicate Reports: Up to the first 15 pages.

$10.73

$10.89

+1.49%

Duplicate Reports: Each additional page after the first 15 pages

$0.25

$0.25

N/A

WC010

Duplication of X-Ray

$5.36

$5.44

+1.49%

WC011

Duplication of Scan

$10.73

$10.89

+1.49%

WC012

Missed Appointments. No fee prescribed / Non-reimbursable absent agreement

$0.00

$0.00

N/A

DaisyBill’s OMFS Calculator -- one of six products offered through our Work Comp Wizard -- already includes these changes in an easy-to-understand and navigate format. Also, if you ever need to look up a historical rate, simply enter the date of service and billing code, then voila! Your expected reimbursement awaits you in all its mathematically accurate glory.

TRY OUT THE OMFS CALCULATOR 

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