The DWC passed changes to the workers’ comp fee schedules, affecting:
- Pathology and clinical laboratory fees
- Relative Value File
- CCI Edits
- Medi-Cal Pharmacy Fee Rates
Workers' compensation billing and processing professionals should adjust their procedures to take into account the following changes:
Pathology and clinical laboratory fees
The DWC posted revisions to the clinical laboratory fee schedule, which included adding several codes, recalculating 24 existing codes, and re-pricing two codes.
These changes are effective for dates of service as of April 15, 2014. For more information, refer to DWC Newsline No. 2014-34.
Relative Value File
The Physician Fee Schedule Relative Value File has also changed, with updated descriptions as well as a column indicating whether or not a physician must be present.
This change is also effective for services rendered on or after April 15, 2014. For more information, refer to DWC Newsline No. 2014-32.
The DWC adopted the first quarterly update to the Physician CCI Edits, as follows:
- Physician CCI Edits v20.1 (851,137 records). The last row contains edit column 1 = 39599 and column 2 = 49570
- Physician CCI Edits v20.1 (744,393 records). The first row contains edit column 1 = 40490 and column 2 = C8950
This change is effective for services rendered on or after April 15, 2014. For more information, refer to DWC Newsline No. 2014-32
Medi-Cal Pharmacy Fee Rates
Reimbursements for dispensed pharmaceuticals changed as of April 16, 2014. Download the current Medi-Cal pharmacy fee rates here (Zip file, 5.68 MB), with active pharmaceutical ingredient fee rates.
Please note that the reimbursements reflected on the DWC’s workers' compensation pharmacy fee schedule (found here) are only for dates of service as of April 16, 2014; past dates of service are not available on the DWC’s pharmacy fee schedule.
The DWC regularly changes the six workers’ comp fee schedules, but at different intervals, so remember to check regulations and updates frequently, and stay on top of compliance.
For easier calculations, use the DaisyBill OMFS-RBRVS Calculator. DaisyBill’s Calculator stays current with every change to all six schedules while preserving past fee schedules, so it can figure reimbursements for every date of service.