Most Frequently Used Procedure Codes: 2016 Work Comp OMFS Changes

February 4, 2016 2 min read

By: Catherine Montgomery

Most Frequently Used Procedure Codes: 2016 Work Comp OMFS Changes

Today’s article focuses on the reimbursement changes to the most frequently used procedure codes in the Physician Fee Schedule of the workers’ comp OMFS. These codes include 99213, 99214, and 99215, for office visits. Good news! For all these codes, the reimbursements increased.

This article is the latest in a series detailing the Physician Fee Schedule changes that took effect on January 1, 2016. To see more, read this summary article: Important 2016 OMFS Changes.

The table below sets out the 2015 and 2016 fees for the most-used procedure codes from the Physician Fee Schedule.

Note: ALL of the procedure codes increased, with the majority of the increases exceeding 5%.

DaisyBill’s Most Frequently Used Procedure Codes

Procedure Code	Description	Facility Dec 2015 Fee	Facility Jan 2016 Fee	Facility Fee % Change	Non-Facility Dec 2015 Fee	Non-Facility Jan 2016 Fee	Non-Facility Fee % Change
99214	Office/outpatient visit est	$94.52	$99.60	5.37%	$132.92	$139.56	5.00%
97140	Manual therapy 1/> regions	$37.08	$39.07	5.37%	$37.08	$39.07	5.37%
97110	Therapeutic exercises	$40.09	$42.24	5.36%	$40.09	$42.24	5.36%
99215	Office/outpatient visit est	$134.10	$140.49	4.77%	$178.59	$187.36	4.91%
99213	Office/outpatient visit est	$61.24	$64.84	5.88%	$89.81	$94.94	5.71%
99205	Office/outpatient visit new	$203.08	$213.98	5.37%	$252.72	$265.79	5.17%
95851	Range of motion measurements	$9.35	$9.85	5.35%	$23.40	$24.66	5.38%
99354	Prolong e&m/psyctx serv o/p	$111.61	$117.91	5.64%	$120.97	$127.78	5.63%
97026	Infrared therapy	$7.50	$7.90	5.33%	$7.50	$7.90	5.33%
97814	Acupunct w/stimul addl 15m	$33.82	$35.63	5.35%	$37.56	$39.58	5.38%
96101	Psycho testing by psych/phys	$93.93	$99.29	5.71%	$94.87	$100.27	5.69%
97813	Acupunct w/stimul 15 min	$40.19	$42.34	5.35%	$47.68	$50.24	5.37%
99204	Office/outpatient visit new	$156.34	$164.74	5.37%	$201.77	$212.60	5.37%
97530	Therapeutic activities	$43.59	$45.93	5.37%	$43.59	$45.93	5.37%
92512	Nasal function studies	$34.75	$36.93	6.27%	$77.84	$81.83	5.13%
95832	Hand muscle testing manual	$19.45	$20.00	2.83%	$38.18	$39.25	2.80%
95831	Limb muscle testing manual	$18.26	$19.25	5.42%	$38.87	$40.46	4.09%
90837	Psytx pt&/family 60 minutes	$149.55	$157.89	5.58%	$150.48	$158.87	5.58%
97810	Acupunct w/o stimul 15 min	$37.15	$39.14	5.36%	$44.64	$47.04	5.38%
94762	Measure blood oxygen level	$32.14	$33.86	5.35%	$32.14	$33.86	5.35%
97112	Neuromuscular reeducation	$41.67	$44.22	6.12%	$41.67	$44.22	6.12%
98940	Chiropract manj 1-2 regions	$27.10	$28.87	6.53%	$34.59	$36.76	6.27%
97811	Acupunct w/o stimul addl 15m	$30.78	$32.43	5.36%	$33.12	$34.90	5.37%

Next, read how the fee schedule change affected Radiology and California Specific Codes and E&M codes.

Work Comp Resources

To take advantage of these increased fees, submit Requests for Authorization (RFAs). Remember: a successful RFA guarantees payment. To find out how and when to file RFAs for work comp, watch DaisyBill’s free RFA webinar:

WATCH RFA WEBINAR

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