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DWC Changes 95% of Path/Lab Reimbursements

January 5, 2017 by Catherine Montgomery

It’s the most wonderful time of the year to be a California workers’ compensation blogger – the changes just keep coming. In today’s update, we take a look at the new adjustment to reimbursements for the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS). These reimbursement changes apply to all dates of service on or after January 1, 2017, and were announced by the Division of Workers’ Compensation (DWC) on December 29th. Shockingly, 95% of reimbursements changed, with most of the adjustments clocking in at a little under one percent.

In analyzing this adjustment to the OMFS, our developers identified the most commonly-used  Pathology and Clinical Laboratory HCPCS across DaisyBill’s California workers’ comp community. Below, you can review the ten most popular Path/Lab HCPCS reimbursement changes for 2017 dates of service. As is often the case, many of these changes are minor. That said, a few notable increases made their way into our top ten.

HCPCS

Reimbursement effective 7/1/2016

Reimbursement effective 1/1/2017

Percent Change

82570

$8.46

$8.52

0.71%

82542

$29.52

$29.72

0.68%

G0483

$258.27

$304.64

17.95%

G0477*

$17.83

N/A - Removed

N/A - Removed

83986

$5.85

$5.89

0.68%

81003

$3.67

$3.69

0.54%

81002

$4.17

$4.20

0.72%

36415

$3.60

$3.60

N/A

80299

$22.39

$22.54

0.67%

83992

$22.81

$24.20

6.09%

*G0477 no longer reimbursable in 2017.

In addition to G0477, four other codes have been removed and are no longer reimbursable: 0010M, 82272, G0478, and G0479.

To compensate for the loss, the DWC added a whopping 16 new Pathology and Clinical Laboratory reimbursable codes:

80305

81413

81539

87631

80306

81414

84410

G0475

80307

81422

87338

G0476

81327

81439

87483

G0659

The DaisyBill OMFS Calculator already incorporates these fee schedule changes. Should you ever need the old reimbursements, we retain the previous reimbursements in our historical database – simply enter a date of service prior to January 1, 2017.

For more information about this update, view the DIR Newsline 2016-124 or visit the DWC website.

In the meantime, stay tuned – we’ll be back with more updates as they continue to roll in.


Curious about our OMFS Calculator? Sign up for a three-day trial and instantly start calculating reimbursements in three seconds or less.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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