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Surgical Codes: The Nitty Gritty on the 2016 Work Comp Fee Schedule Changes

January 4, 2016 by Catherine Montgomery

In case you missed it, every single fee in the workers’ comp Physician Fee Schedule changed on January 1, 2016. Yes, every single one.

My recent article, 2016 Changes to Workers’ Comp Physician and Non-Physician Fee Schedule, summarizes the major changes. Today’s article takes a closer look and explains how the new fee schedule impacts your bottom line.

Surgical Code Fee Reductions

The table below displays the surgical procedure codes most frequently used by 1,400+ DaisyBill users. Sorted by frequency, the table compares the old December 2015 fees to the new January 2016 fees for surgical procedures rendered in both facility and non-facility settings.

As you can see, the new fee schedule reduces ALL procedure codes fees for surgical procedures. Most surgical procedure code fees decrease by at least 6%.

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

20610

Drain/inj joint/bursa w/o us

$71.93

$67.47

-6.20%

$95.34

$89.32

-6.31%

20550

Inj tendon sheath/ligament

$65.41

$61.03

-6.70%

$94.23

$87.92

-6.70%

29240

Strapping of shoulder

$28.95

$27.02

-6.67%

$46.36

$43.26

-6.69%

62284

Injection for myelogram

$136.58

$126.73

-7.21%

$299.26

$278.53

-6.93%

64483

Inj foramen epidural l/s

$179.81

$168.34

-6.38%

$358.10

$338.06

-5.60%

64484

Inj foramen epidural add-on

$81.71

$77.16

-5.57%

$141.14

$133.73

-5.25%

29826

Shoulder arthroscopy/surgery

$274.64

$253.98

-7.52%

$274.64

$253.98

-7.52%

20605

Drain/inj joint/bursa w/o us

$57.88

$54.36

-6.08%

$78.89

$74.53

-5.53%

17000

Destruct premalg lesion

$84.73

$79.77

-5.85%

$106.94

$100.50

-6.02%

29823

Shoulder arthroscopy/surgery

$983.55

$923.61

-6.09%

$983.55

$923.61

-6.09%

17003

Destruct premalg les 2-14

$3.73

$3.48

-6.70%

$9.13

$8.52

-6.68%

29530

Strapping of knee

$28.35

$26.81

-5.43%

$45.16

$43.06

-4.65%

64555

Implant neuroelectrodes

$246.51

$228.90

-7.14%

$342.56

$319.08

-6.85%

62311

Inject spine lumbar/sacral

$142.26

$133.86

-5.90%

$364.97

$346.16

-5.15%

17004

Destroy premal lesions 15/>

$157.66

$148.19

-6.01%

$241.71

$226.61

-6.25%

29877

Knee arthroscopy/surgery

$988.55

$926.34

-6.29%

$988.55

$926.34

-6.29%

64450

N block other peripheral

$72.45

$68.16

-5.92%

$130.68

$121.94

-6.69%

29881

Knee arthroscopy/surgery

$862.08

$808.28

-6.24%

$862.08

$808.28

-6.24%

62310

Inject spine cerv/thoracic

$172.54

$162.68

-5.71%

$394.66

$373.30

-5.41%

Stay tuned for future articles with similar tables for radiology, Evaluation / Management, California-specific codes, and more–including codes with increased reimbursement.

If you’d rather get all the information in one fell swoop, download the slides and video from our recent webinar. The downloads include all the tables and provide step-by-step instructions for calculating the new reimbursements.

Or, to make it super easy to keep up with this and other frequent fee schedule changes, sign up for the DaisyBill Calculator. It’s easy, instant, and FREE for a three day trial.

TRY THE CALCULATOR

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