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Outpatient/ASC Fee Schedule: DWC Issues (Then Corrects) Reimbursements

March 15, 2018 by Catherine Montgomery

The California Division of Workers’ Compensation (DWC) ordered new adjustments to the Official Medical Fee Schedule (OMFS), effective March 15, 2018. The orders update fees for hospital outpatient departments and Ambulatory Surgical Center (ASC) services.

Pursuant to California Labor Code § 5307.1, DWC Acting Administrative Director George P. Parisotto’s update orders brought the outpatient/ASC fee schedule into conformity with CMS’ HOPPS rules. Most recently, the DWC issued an order correcting an error in a previous order’s update to California Code of Regulations (CCR) Section 9789.34’s Table A.

Among the initial February order’s key points were the following:

  1. A reduction in payment for some X-ray services: The OMFS adopts Code of Federal Regulations (CFR) Section 419.71 payment rules into CCR §9789.39(a), lowering reimbursement for film X-ray imaging and radiography imaging services.
  2. A change in clinical laboratory services status code indicators: The order deletes Status indicator Q4 from CCR §9789.32 for services rendered on or after 12/15/2016, as clinical laboratory services are not “supply, drug, device, blood product, or biological” as defined in §9789.32(a)(1) and are not “integral part of an emergency room visit, surgery, or Other Service...”
  3. New Composite APC (Status Codes Q1 through Q4) and Comprehensive APC (C-APC, Status Codes J1 and J2) payment rules: these changes to CCR  §9789.39(b) are “declaratory of existing regulations.”
  4. Changes to the wage index value by county: CCR § 9789.34 reflects those changes and an updated conversion factor.

Regarding the last point, the DWC issued a follow-up order on February 27th, correcting an error in the update to CCR § 9789.34’s Table A. A revised Table A replaces the one established in the first order, as it apparently listed Los Angeles County twice (complete with different county-specific wage indexes and wage-adjusted conversion factors). Whoops.

According to the order, the correct, “final answer” wage index for Los Angeles County is 1.2778, and the correct wage-adjusted conversion factor is $94.04.

As always, the DWC’s OMFS Page features downloadable copies of each and every order, including the superseded regulations featuring the mistake in Table A, for posterity.

We’ll keep readers updated on any other major changes to the OMFS.

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