Radiology and California Specific Codes: 2016 Fee Schedule Changes
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
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
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% |
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