Telehealth Medicare Restrictions Not Adopted by DWC

Telehealth Medicare Restrictions Not Adopted by DWC

Several weeks ago, we covered the emerging field of telehealth and its powerful ability to alter the California workers’ comp landscape. Reimbursement for these telehealth services was clarified by the recent adjustment to the Physician and Non-Physician Fee Schedule, effective for 2017 dates of service on or after March 1.

With the changes to the Physician and Non-Physician Fee Schedule, telehealth services are now assigned a dedicated place of service code, along with a new array of reimbursable CPT codes. Furthermore, the DWC has not adopted Medicare’s restrictions to telehealth, meaning that any capable California provider is now able to render these services to any injured worker.

Medicare greatly limits reimbursement for telehealth by placing stringent requirements on which practices may offer telehealth services. Per Medicare, the beneficiary must be located in a rural area, as determined by the CMS.

Not so for California workers’ comp – by choosing not to adopt the Medicare requirements, the DWC opened the door for providers to embrace available technology and extend their reach around the state. As the boundary between healthcare and technology continues to dissolve, telehealth is unlikely to go away anytime soon. 

Its potential to reduce missed appointments alone makes it an intriguing opportunity for workers’ comp providers. As a reminder, providers must always receive authorization for any medical treatment, including telehealth services. Furthermore, providers billing for telehealth services must use the facility payment rate. This rate, calculated as part of the Practice Expense RVU (RVUPE), is generally lower than its non-facility counterpart, as it does not include overhead expenses. Nonetheless, any practice that offers telehealth services is well positioned to take advantage of this intriguing emerging field.

We plan to closely monitor telehealth developments throughout the year and report back with updates or data. If your practice currently offers or is planning to offer telehealth services, please don’t hesitate to get in touch – we’d love to hear from you.

The DaisyBill OMFS Calculator – one of the six products offered through our Work Comp Wizard – is updated every time the DWC adjusts the workers’ comp fee schedule. That means that our clients never have to worry about out-of-date reimbursements. Should you ever need to access old reimbursements, simply enter a date of service prior to the date of the last OMFS changes.

If you’re curious about our Calculator, sign up below for a three-day trial to the Work Comp Wizard. You’ll be able to start calculating 2017 work comp reimbursements instantly, and you’ll gain access to a suite of other workers’ comp billing tools.


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