On September 17, 2015 the Division of Workers’ Compensation (DWC) posted revisions to the Official Medical Fee Schedule (OMFS) and updated two fee schedules:

• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
• Physician Services and Non-Physician Practitioner Services

For easier calculations, use daisyBill’s OMFS Calculator. daisyBill’s Calculator already includes the new fee schedules, making it a snap to calculate the new reimbursements.

DMEPOS

For dates of service on or after October 1, 2015, the DWC updated the DMEPOS fee schedule to reflect Medicare changes to the payment system.

Specifically, these changes affect the maximum reasonable fees for Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) which shall not exceed 120% of updated California Medicare fees.

To access the updated fee schedule files to determine new reimbursement amounts:

• Download the “DME15-D [ZIP, 2MB]” file from the CMS.gov website.

For more information, see:

• DWC Order of the Administrative Director of the DWC
• Newsline 2015-85 of the Department of Industrial Relations (DIR)

Physician Services / Non-Physician Practitioner Services

For dates of service on or after October 1, 2015, the DWC also adjusted the Physician and Non-Physician Practitioner portion of the OMFS to reflect quarterly Medicare changes.

To access the updated fee schedule files to determine new reimbursement amounts:

• National Correct Coding Initiative Medically Unlikely Edits (MUEs):

• Navigate to the Medically Unlikely Edits section of the DWC website and download the October 2015 MUE file.

• National Correct Coding Initiative Physician/Practitioner Services CCI Edits:

• At the bottom of the cms.gov webpage on PTP Coding Edits, download the appropriate file(s) for October 1, 2015.

• CMS’ Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU15D:

• Open DWC Regulations.
• Scroll down to pages 62 - 63, which is part of the Update Table, Subsection b.
• Toward the bottom, find the section labeled “CMS’ Medicare National Physician Fee Schedule Relative Value File [Zip].”
• Find the October 1, 2015 update and download the RVU15D file.

For more information, see:

• Physician services section of the DWC’s OMFS webpage
• Newsline 2015-84 of the DIR

Try daisyBill’s OMFS Calculator. It’s FREE for three days and always up-to-date for every date of service.

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Read More about Workers' Compensation Fee Schedules in these related posts:

• 2015 Work Comp OMFS Changes - Still Waiting
• Take Care When Looking Up Fee Schedule Reimbursement for Work Comp