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Changes to OMFS: Pharmaceutical, DMEPOS, and Physician Fee Schedule

The DWC passed major changes to the workers’ compensation fee schedules, affecting reimbursements for pharmaceutical NDC numbers, DMEPOS, and splinting and casting Q codes.  

Providers and claims administrators must adjust their billing and processing practices immediately as the changes are effective now and even retroactive to dates of service on or after 4/1/2014.


Effective 3/26/2014, the pharmaceutical fee schedule was drastically revised.  Over 42,000 NDC numbers were removed as reimbursable while the reimbursement amounts changed for more than 4,800 of the remaining NDC numbers.


The new DMEPOS fee schedule includes new reimbursements for DMEPOS for dates of service 4/1/2014.

Splinting and Casting Q Codes

Per the Physician Fee Schedule in the OMFS, as of 1/1/2014, Q codes for splinting and casting supplies are payable.  For dates of service 4/1/2014, the reimbursement for splinting and casting supplies increased by 20%.

Use DaisyBill's OMFS Calculator to quickly and easily determine what is due per California's OMFS.

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Originally published on Petal to the Metal and migrated to this blog upon the merger of the two blogs.

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