OMFS Update: Reimbursement Change For Pathology and Clinical Laboratory Services

OMFS Update: Reimbursement Change For Pathology and Clinical Laboratory Services

California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule, bringing the OMFS into line with Medicare’s 2018 third quarter changes to reimbursement.

The update adds one billing code, 0037U for targeted gene sequencing. The change is effective for service rendered on or after July 1, 2018.

California Labor Code Section 5307.1 requires the DWC to align the OMFS with the Medicare payment system. For Pathology and Clinical Laboratory Services, the OMFS must list reimbursement at 120% of the relevant Medicare reimbursement rate.

The DWC order, announced in a recent Newsline, incorporates by reference Medicare’s July 2018 quarterly update. The quarterly update is accessible under the file name “18CLABQ3” on the Center for Medicare and Medicaid Services (CMS) website.  

The update creates a new billing code as follows:

New Billing Code


Reimbursement from 7/1/2018


Trgt gen seq dna 324 genes


We’ll keep our readers updated of any further reimbursement changes. As always, DaisyBill’s OMFS Calculator and Billing Software are updated to reflect the latest orders.

Never worry about calculating the correct reimbursement again. DaisyBill’s OMFS Calculator, included in our Work Comp Wizard, automatically calculates the right payment, every time. Try it free today.


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