CA OMFS Update: Pathology & Clinical Laboratory

CA OMFS Update: Pathology & Clinical Laboratory

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:

Procedure Code

Description

OMFS Reimbursement 4/1/2022

OMFS Reimbursement 1/1/2022

Reimbursement Difference

0108U

Gi barrett esoph 9 prtn bmrk

$2,820.00

$3,015.90

-$195.90

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

New Pathology & Clinical Laboratory Procedure Codes, Q2 2022

New Procedure Code

Description

OMFS Reimbursement

0306U

Onc mrd nxt-gnrj alys 1st

$0.00

0307U

Onc mrd nxt-gnrj alys sbsq

$0.00

0308U

Crd cad alys 3 prtn plsm alg

$0.00

0309U

Crd cv ds aly 4 prtn plm alg

$0.00

0310U

Ped vsclts kd alys 3 bmrks

$0.00

0311U

Nfct ds bct quan antmcrb sc

$0.00

0312U

Ai ds sle alys 8 igg autoant

$0.00

0313U

Onc pncrs dna&mrna seq 74

$0.00

0314U

Onc cutan mlnma mrna 35 gene

$0.00

0315U

Onc cutan sq cll ca mrna 40

$0.00

0316U

B brgdrferi lyme ds ospa evl

$0.00

0317U

Onc lung ca 4-prb fish assay

$0.00

0318U

Ped whl gen mthyltn alys 50+

$0.00

0319U

Neph rna pretrnspl perph bld

$0.00

0320U

Neph rna psttrnspl perph bld

$0.00

0321U

Iadna gu pthgn 20bct&fng org

$0.00

0322U

Neuro asd meas 14 acyl carn

$0.00

Deleted Pathology & Clinical Laboratory Procedure Codes, Q2 2022

Deleted Procedure Code

Description

Former OMFS Reimbursement

0097U

Gi pathogen 22 targets

$435.64

0151U

Nfct bct/vir resp nfctj 33

$229.32


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