CA OMFS Update: Outpatient/ASC

CA OMFS Update: Outpatient/ASC

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:

Procedure Code

Status Indicator

Description

Reimbursement 4/1/2022 (Los Angeles County)

Reimbursement 3/1/2022 (Los Angeles County)

Reimbursement Difference

C9781

J1

Arthro/shoul surg; w/spacer

$6,458.67

$0.00

+$6,458.67

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.

TRY THE CALCULATOR

How did you like the article ?

DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.