OMFS Update: DWC Orders Changes to Pathology/Clinical Lab Fee Schedule

OMFS Update: DWC Orders Changes to Pathology/Clinical Lab Fee Schedule

The DWC posted an update order bringing the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) into line with Medicare.

The order removes three Current Procedural Terminology (CPT) codes from the schedule, adds one new CPT code, and significantly increases reimbursement for one CPT code. Importantly, this update is RETROACTIVE to dates of service April 1, 2018.

The DWC announced the order in a Newsline on April 30th. The order, available on the DWC website, updates California Code of Regulations (CCR) Section 9789.50.

Per California Labor Code Section 5307.1, the OMFS must conform to changes in Medicare reimbursement rates.

The Medicare change in question is the April 2018 quarterly update to the Medicare Clinical Laboratory Fee Schedule, contained in CMS file 18CLABQ2. OMFS reimbursements for pathology and clinical laboratory services may not exceed 120% of Medicare rates.

The following changes are effective for services rendered on or after April 1, 2018:

  • CPT Code 87634:QW is added to the fee schedule
  • CPT Codes 81280, 81281, and 81282 are removed from the fee schedule
  • Reimbursement for CPT Code 80410 is increased from $39.69 to $119.08

Just for good measure, we’ll say it again: these changes are retroactive to April 1. Providers should bill according to the updated fee schedule for all dates of service from April 1 onward.

As always, we’ll keep readers informed of any other significant changes to the OMFS.

The best way to stay on top of OMFS changes? DaisyBill’s OMFS Calculator, included in our Work Comp Wizard. Instantly calculate reimbursements, worry-free. Enjoy a free trial, and see how easy it can be.


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