OMFS & COVID-19: Updates to Pathology Fee Schedule

OMFS & COVID-19: Updates to Pathology Fee Schedule

California’s Division of Workers Compensation (DWC) ordered adjustments to the Pathology and Clinical Laboratory Section of the state’s Official Medical Fee Schedule (OMFS) for workers’ compensation.

Effective April 1, 2020, the DWC order adds two new billing codes specifically for COVID-19 testing.

Novel Coronavirus Testing Codes

The DWC order adopts the following Health Care Common Procedure Coding System (HCPCS) codes for workers’ comp

Billing Code

Procedure

Maximum CA Workers’ Comp Fee

U0001

CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel

$43.09

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

$61.57

California Labor Code Section 5307.1 aligns the OMFS with Medicare, requiring workers’ compensation fee schedules to reflect changes in Medicare billing and payment. The Centers for Medicare and Medicaid Studies (CMS) adopted HCPCS U0001 and HCPCS U0002, as listed in the April 2020 CMS quarterly update file for Medicare’s Clinical Laboratory Fee Schedule.

As national payment amounts for both tests are not yet established, the fees were calculated per the CMS’ Medicare Administrative Contractor’s local rate for California, published here.

We welcome any and all questions or concerns providers may have, as we navigate the new reality of COVID-19 together. Email info@daisybill.com, and we will address the most frequently asked questions in this space.

To learn about why E-billing is critical during COVID-19 and the details of how workers' comp E-billing is different from group health or Medicare, sign-up for our free upcoming webinar below.


For more on telehealth rules for Medicare, California health insurers, and California workers’ compensation, look through the free resources available on our COVID-10 page.

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