OMFS Update: 59 Codes Newly Billable

July 5, 2021 2 min read

By: Catherine Montgomery

California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation, effective for dates of service on or after July 1.

Among the changes, 59 billing codes previously deemed “invalid” for reimbursement are now billable with reimbursement established ‘By Report’.

Newly Billable Procedure Codes

The DWC announced the update in a recent Newsline, and posted the order adopting the update on the Physician and Non-Physician Practitioner Fee Schedule page of the DWC website.

The order makes the codes listed below billable “by report.” Previously, the below codes were invalid:

Billing Code	Procedure
A9593	Gallium ga-68 psma-11 ucsf
A9594	Gallium ga-68 psma-11, ucla
D0606	Molecular test pub hlth path
D1701	Pfizer vacc admin 1st dose
D1702	Pfizer vacc admin 2nd dose
D1703	Moderna vacc admin 1st dose
D1704	Moderna vacc admin 2nd dose
D1705	AstraZeneca vacc adm 1st dos
D1706	AstraZeneca vacc adm 2nd dos
D1707	Janssen vaccine admin
G0327	Colon ca scrn;bld-bsd biomrk
J0224	Inj. lumasiran, 0.5 mg
J1951	Inj fensolvi 0.25 mg
J7168	Prothrombin complex kcentra
J9348	Inj. naxitamab-gqgk, 1 mg
J9353	Inj. margetuximab-cmkb, 5 mg
M0244	Casirivi and imdevi infus hm
M0245	Bamlan and etesev infusion
M0246	Bamlan and etesev infus home
Q0245	Bamlanivimab and etesevima
Q5123	Inj. riabni, 10 mg
0031A	Adm sarscov2 vac ad26 .5ml
0640T	Ncntc nr ifr spctrsc wnd
0641T	Ncntc nr ifr spctrsc wnd img
0642T	Ncntc nr ifr spctrsc wnd i&r
0643T	Tcat l ventr rstrj dev implt
0644T	Tcat rmvl/dblk icar mas perq
0645T	Tcat impltj c sins rdctj dev
0646T	Ttvi/rplcmt w/prstc vlv perq
0647T	Insj gtube perq mag gastrpxy
0648T	Quan mr alys tiss w/o mri
0649T	Quan mr alys tiss w/mri
0650T	Prgrmg dev eval scrms remote
0651T	Mag ctrld capsule endoscopy
0652T	Egd flx transnasal dx br/wa
0653T	Egd flx transnasal bx 1/mlt
0654T	Egd flx transnasal tube/cath
0655T	Tprnl focal abltj mal prst8
0656T	Vrt bdy tethering ant <7 seg
0657T	Vrt bdy tethering ant 8+ seg
0658T	Elec impd spectrsc 1+skn les
0659T	Tcat intra-c nfs supersat O2
0660T	Implt ant sgm io nbio rx sys
0661T	Rmvl&rimpltj ant sgm implt
0662T	Scalp cool 1st meas&calbrj
0663T	Scalp cool plmt mntr rmvl
0664T	Don hysterectomy open cdvr
0665T	Don hysterectomy open liv
0666T	Don hysterectomy laps liv
0667T	Don hysterectomy rcp uter
0668T	Bkbench prep don uter algrft
0669T	Bkbench rcnstj don uter ven
0670T	Bkbench rcnstj don uter artl
90626	Tic-brn enceph vac 0.25ml im
90627	Tic-brn enceph vac 0.5ml im
90671	Pcv15 vaccine im
90677	Pcv20 vaccine im
90758	Zaire ebolavirus vac live im
91303	Sarscov2 vac ad26 .5ml im

As always, we’ll keep our readers updated with any further updates to the OMFS.

We keep track of the OMFS so you don’t have to. Try our DaisyWizard OMFS Calculator free, and see how much easier workers’ comp billing can be.

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