On March 30, 2022, the California Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS), bringing the OMFS in line with Medicare’s 2022 second quarter changes to reimbursement.

The update deletes 2 billing codes and adds 18 new billing codes; the reimbursement rate for all the new codes is $0.00.

Additionally, the order maintains prices set at 120% of Medicare rates for COVID-19-related testing codes, one of which was altered by a subsequent update to Medicare’s second quarter changes.

This update is retroactive to dates of service rendered on or after April 1, 2022.

Per California Labor Code Section 5307.1, the DWC order (announced in a recent Newsline) incorporates by reference Medicare’s April 2022 quarterly update to its Clinical Laboratory Fee Schedule. OMFS reimbursement for Pathology and Clinical Laboratory services is set at 120% of the applicable fees in the Medicare electronic file “22LABQ2_0,” which Medicare subsequently revised on March 31, 2022.  

The order also maintains COVID-19-related testing codes and prices set at 120% of the price set by the California Medicare Administrative Contractor Noridian. Medicare’s March 31 revision to the 22CLABQ2_0 file decreases the reimbursement for one proprietary laboratory analysis code, as follows:

The newly added and deleted Pathology and Clinical Laboratory procedure codes are outlined below.

New Pathology & Clinical Laboratory Procedure Codes, Q2 2022

Deleted Pathology & Clinical Laboratory Procedure Codes, Q2 2022

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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