Location-Based Adjustments (GPCIs) Now in Effect for California, as of January 1, 2019

For better or worse, location-based adjustments are here for California workers’ comp. Find out how they impact reimbursements in 2019.

As our preliminary calculations indicate, net reimbursements will decrease by 3-4% for many areas, whereas the most expensive locations will receive at least a 10% increase over 2018 reimbursements.

The California Division of Workers’ Compensation (DWC) modified the Physician Fee Schedule, effective for dates of service as of January 1, 2019. Changes to this fee schedule include the adoption of Medicare Geographic Practice Cost Indices (GPCIs), in 8 CCR § 9789.12.2(e)(2), to calculate reimbursement for physician and non-physician services.

With the adoption of GPCIs, we crunched the numbers to determine the impact on 2019  reimbursements. The following are a few selected examples of reimbursements using the new GPCI formula:

Expected Reimbursements 2018 vs. 2019 GPCIs (selected regions)

CPT

2018
Statewide
Reimbursement

2019
Low
Reimbursement

2019
Median Reimbursement

2019
High Reimbursement

99204

$225.94

$217.05

$221.30

$247.95

99214

$149.32

$144.63

$147.68

$166.91

97162

$117.48

$114.04

$116.44

$131.87

The regions selected above represent the median, lower, and upper ends of the GPCIs.

  • For the median regions (such as San Diego / Carlsbad), 2019 reimbursements dip by a range of 1-2% compared to 2018 reimbursements.
  • Most other areas (Chico, El Centro, Fresno, Bakersfield, etc.) see a 3-4% reduction in 2019 reimbursements.
  • The most expensive region (San Jose / Sunnyvale / Santa Clara) can expect to see an increase of 10-12% in 2019 reimbursements.

We have already seen some reimbursement tomfoolery from payers. In coming blogs, we will show you how payers are incorrectly reimbursing providers.

With GPCIs potentially adding more chaos to the billing and reimbursement landscape, providers should get ready to file more appeals. Your friends here at DaisyBill have your back, with software that makes 5-second appeals possible. Three clicks and your second review request is done!

FIND OUT HOW

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