Blog: Daisy News

News, data, & insights about workers' comp billing

header_illustration_blogDaisyBill

Radiology and California Specific Codes: 2016 Fee Schedule Changes

January 26, 2016 by Catherine Montgomery

As part of an ongoing series on Important 2016 OMFS Changes implemented by the California Division of Workers’ Compensation, this article focuses on reimbursement changes to the Physician Services Fee Schedule; specifically, to the radiology and California specific codes.

The reimbursements for both sets of codes changed dramatically when the DWC updated the Physician Fee Schedule on January 1st, 2016.

Radiology Codes

Radiology Codes for Workers' Comp OMFS

This table lists the radiology codes most used by DaisyBill’s clients, sorted by frequency. For radiology procedures, the fee is the same whether provided in a facility or a non-facility setting.

Note: The majority of the reductions exceed 5%.

Procedure Code

Description

Facility Dec 2015 Fee

Facility Jan 2016 Fee

Facility Fee %  Change

Non-Facility Dec 2015 Fee

Non-Facility Jan 2016 Fee

Non-Facility Fee % Change

72110

X-ray exam l-2 spine 4/>vws

$77.18

$73.19

-5.17%

$77.18

$73.19

-5.17%

73030

X-ray exam of shoulder

$45.52

$43.24

-5.01%

$45.52

$43.24

-5.01%

77003

Fluoroguide for spine inject

$135.51

$129.79

-4.22%

$135.51

$129.79

-4.22%

73221

Mri joint upr extrem w/o dye

$375.11

$355.96

-5.11%

$375.11

$355.96

-5.11%

72148

Mri lumbar spine w/o dye

$352.16

$334.26

-5.08%

$352.16

$334.26

-5.08%

72040

X-ray exam neck spine 2-3 vw

$52.27

$49.63

-5.05%

$52.27

$49.63

-5.05%

72100

X-ray exam l-s spine 2/3 vws

$55.19

$52.39

-5.07%

$55.19

$52.39

-5.07%

73110

X-ray exam of wrist

$56.08

$53.23

-5.08%

$56.08

$53.23

-5.08%

73100

X-ray exam of wrist

$46.22

$43.91

-5.00%

$46.22

$43.91

-5.00%

72141

Mri neck spine w/o dye

$353.91

$335.91

-5.09%

$353.91

$335.91

-5.09%

73721

Mri jnt of lwr extre w/o dye

$374.52

$356.51

-4.81%

$374.52

$356.51

-4.81%

73564

X-ray exam knee 4 or more

$63.14

$59.56

-5.67%

$63.14

$59.56

-5.67%

73130

X-ray exam of hand

$48.12

$46.06

-4.28%

$48.12

$46.06

-4.28%

73562

X-ray exam of knee 3

$54.27

$53.72

-1.01%

$54.27

$53.72

-1.01%

73020

X-ray exam of shoulder

$36.37

$34.04

-6.41%

$36.37

$34.04

-6.41%

73560

X-ray exam of knee 1 or 2

$46.16

$46.66

1.08%

$46.16

$46.66

1.08%

71020

Chest x-ray 2vw frontal&latl

$43.74

$41.36

-5.44%

$43.74

$41.36

-5.44%

72050

X-ray exam neck spine 4/5vws

$70.40

$67.12

-4.66%

$70.40

$67.12

-4.66%

73610

X-ray exam of ankle

$49.66

$47.16

-5.03%

$49.66

$47.16

-5.03%

73080

X-ray exam of elbow

$49.66

$46.61

-6.14%

$49.66

$46.61

-6.14%

California Specific Codes

California-specific Codes for Workers' Comp OMFS

The table below lists the new fees for selected California Specific Codes. Compared to the December 2015 Physician Fee Schedule, all these California-specific codes increased in January 2016.

Note: All California Specific code fees increase by approximately 1%.

California Specific Code

Description

Dec 2015 Fee

Jan 2016 Fee

Fee% Change

WC001

Doctor's First Report of Occupational Illness or Injury (Form 5021)

$0.00

$0.00

0.00%

WC002

Treating Physician's Progress Report

$12.01

$12.14

1.08%

WC003

Primary Treating Physician’s Permanent and Stationary Report (Form PR-3)

$38.99

$39.42

1.10%

WC004

Primary Treating Physician’s Permanent and Stationary Report (Form PR-4)

$38.99

$39.42

1.10%

WC005

Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report.

$38.99

$39.42

1.10%

WC007

Consultation Reports Requested by the Workers’ Compensation Appeals Board or the Administrative Director

$38.99

$39.42

1.10%

WC008

Chart Notes

$10.34

$10.45

1.06%

 


Try the DaisyBill OMFS Calculator, included with our Work Comp Wizard

TRY THE CALCULATOR

Search results for:

intercom_chat_bubble_icon