California’s Division of Workers’ Compensation (DWC) ordered updates to the Hospital Outpatient and Ambulatory Surgical Center (ASC) portion of the Official Medical Fee Schedule (OMFS), effective April 1, 2022. The updates bring the OMFS into line with changes to the Medicare payment system, as required by law.

The update alters only a single billing code, C9781. Previously invalid, C9781 is valid and reimbursable for dates of service on or after April 1, 2022.

ASC/Outpatient Reimbursement Change

California Labor Code Section 5307.1 requires regularly updating the OMFS to keep workers’ comp reimbursement rates in alignment with Medicare.

The OMFS pegs reimbursement rates for both hospital outpatient and ASC services to Medicare’s Hospital Outpatient Fee Schedule. Workers’ comp hospital outpatient rates may not exceed 120% of Medicare hospital outpatient rates, while workers’ comp ASC services rates may not exceed 80% of Medicare hospital outpatient rates.

The update order, announced in a recent DWC Newsline, allows reimbursement for procedure code C9781, amounts for which will vary by locality. As an example, the reimbursement rate for Los Angeles County is as follows:

daisyBill software is updated to reflect the latest changes; our provider clients will continue to obtain the most up-to-date correct reimbursement. As always, we’ll keep all our readers up to speed with any new OMFS developments in this space.

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

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