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Most Frequently Used Procedure Codes: 2016 Work Comp OMFS Changes

February 4, 2016 by Catherine Montgomery

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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