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Ultimate 2018 Workers’ Comp Reimbursement Cheat Sheet

February 2, 2018 by Catherine Montgomery

Here it is: your complete, downloadable go-to resource for California workers’ comp reimbursement rates in 2018. This guide features the Official Medical Fee Schedule (OMFS) reimbursements for the procedure codes providers use most, including:

  • Evaluation & Management (E/M)
  • Surgery
  • Radiology (Professional Services)

...and more, plus reimbursements for medical-legal services! All OMFS reimbursements are effective for dates of service on or after January 1, 2018.

To download the cheat sheet as a printable pdf, head to our Webinar Library. While you’re there, feel free to download our 2018 OMFS Webinar video and slides as well.

Evaluation and Management (E/M) Services

Reimbursement for all E/M codes are modestly higher in 2018 (generally under 3%), with the exception of an 8.09% increase for CPT code 99211.

Billing Code

Description

Reimbursement (Non-Facility) December 2017

Reimbursement (Non-Facility)     January 2018  

Reimbursement Difference

Percent Change

99202

Office/outpatient visit new

$102.77

$104.53

$1.76

+1.68%

99203

Office/outpatient visit new

$147.37

$149.04

$1.67

+1.12%

99204

Office/outpatient visit new

$222.40

$225.94

$3.54

+1.57%

99205

Office/outpatient visit new

$279.16

$283.28

$4.12

+1.45%

99211

Office/outpatient visit est

$28.40

$30.90

$2.5

+8.09%

99212

Office/outpatient visit est

$60.39

$61.67

$1.28

+2.08%

99213

Office/outpatient visit est

$100.18

$101.39

$1.21

+1.19%

99214

Office/outpatient visit est

$147.02

$149.32

$2.30

+1.54%

99215

Office/Outpatient Visit (est)

$197.13

$200.52

$3.39

+1.69%

99233

Subsequent Hospital Care

$139.26

$140.73

$1.47

+1.04%

Surgery

Most surgery reimbursements saw a modest increase, from less than a single percent to just under 7 percent. There are two notable exceptions: CPT Code 17004 dropped by 2.64%, from $209.61 to $204.21. Meanwhile, reimbursement for implanting neuroelectrodes (CPT Code 64555) skyrocketed by over 83%, from $293.20 to $1762.01, a difference of $1468.81.

Billing Code

Description

Reimbursement (Non-Facility) December 2017

Reimbursement (Non-Facility)     January 2018  

Reimbursement Difference

Percent Change

11100

Biopsy skin lesion

$145.34

$150.86

$5.52

+3.66%

17000

Destruct premalg lesion

$93.08

$93.68

$0.60

+.64%

17004

Destroy premal lesions 15/>

$209.61

$204.21

$5.40

- 2.64%

20550

Inj tendon sheath/ligament

$71.83

$73.12

$1.29

+1.76%

20605

Drain/inj joint/bursa w/o us

$68.80

$70.07

$1.27

+1.81%

20610

Drain/inj joint/bursa w/o us

$82.38

$83.21

$0.83

+1%

20611

Drain/inj joint/bursa w/us

$124.99

$126.05

$1.06

+.84%

29823

Shoulder arthroscopy/surgery

$846.67

$856.33

$9.66

+1.13%

29826

Shoulder arthroscopy/surgery

$235.46

$236.79

$1.33

+.56%

29827

Arthroscop rotator cuff repr

$1435.53

$1449.80

$14.27

+.98%

29877

Knee arthroscopy/surgery

$847.05

$856.36

$9.31

+1.09%

36415

Routine venipuncture

$3.60

$3.60

N/A

N/A

62284

Injection for myelogram

$263.75

$271.57

$7.82

+2.88%

64450

N block other peripheral

$112.28

$114.24

$1.96

+1.72%

64483

Inj foramen epidural l/s

$306.84

$312.22

$5.38

+1.72%

64484

Inj foramen epidural add-on

$121.61

$130.51

$8.90

+6.82%

64493

Inj paravert f jnt l/s 1 lev

$240.78

$245.50

$4.72

+1.92%

64494

Inj paravert f jnt l/s 2 lev

$119.31

$121.29

$1.98

+1.63%

64555

Implant neuroelectrodes

$293.20

$1762.01

$1468.81

+83.36%

Radiology (Professional Services, Modifier -26)

Most services saw a modest increase of less than 2%, with the exception of CPT Code 73100 for an x-ray examination of the wrist, which rose by over 5% to $12.02.

Billing Code

Description

Reimbursement (Non-Facility) December 2017

Reimbursement (Non-Facility)     January 2018  

Reimbursement Difference

Percent Change

72040

X-ray exam neck spine 2-3 vw

$15.20

$15.38

$0.18

+1.17%

72070

X-ray exam thorac spine 2vws

$15.20

$15.38

$0.18

+1.17%

72100

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

$15.20

$15.38

$0.18

+1.17%

 

72110

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

$21.24

$21.47

$0.23

+1.07%

 

72148

Mri lumbar spine w/o dye

$100.60

$101.16

$0.56

+.55%

72170

X-ray exam of pelvis

$11.84

$11.97

$0.13

+1.09%

73020

X-ray exam of shoulder

$10.91

$11.02

$0.11

+1%

73030

X-ray exam of shoulder

$12.82

$12.96

$0.14

+1.08%

73100

 X-ray exam of wrist

$11.37

$12.02

$0.65

+5.41%

73110

 X-ray exam of wrist

$11.84

$11.97

$0.13

+1.09%

73120

X-ray exam of hand

$11.37

$11.50

$0.13

+1.13%

73130

X-ray exam of hand

$11.84

$11.97

$0.13

+1.09%

73221

Mri joint upr extrem w/o dye

$92.18

$92.66

$0.48

+.52%

73560

X-ray exam of knee 1 or 2

$11.37

$11.50

$0.13

+1.13%

73562

X-ray exam of knee 3

$12.82

$12.96

$0.14

+1.08%

73564

X-ray exam knee 4 or more

$15.20

$15.38

$0.18

+1.17%

73610

X-ray exam of ankle

$11.84

$11.97

$0.13

+1.09%

73721

Mri jnt of lwr extre w/o dye

$91.66

$92.66

$1.00

+1.08%

76881

Us compl joint r-t w/img

$42.66

$43.14

$0.48

+1.11%

Medical-Legal Services

Codes ML100, ML102, and ML103 are flat-rate service-based fees, while ML101, ML104, ML105, and ML106 are time-based. Reimbursement rates remain unchanged from the 2017 rates. All medical-legal billing code modifiers (93, 94, and 95) are included in the tables below.

Medical-Legal Reimbursements, Non-Time-Based

Billing Code

Procedure

Modifier(s)

Reimbursement

ML100

Missed Appointment

N/A

By Report

ML102

Basic Comprehensive Medical-Legal Evaluation

None

$625.00

ML102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter)

$687.50

ML102

Basic Comprehensive Medical-Legal Evaluation

94 (AME)

$781.25

ML 102

Basic Comprehensive Medical-Legal Evaluation

95 (Panel QME)

$625.00

ML 102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 94 (AME)

$843.75

ML 102

Basic Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 95 (Panel QME)

$687.50

ML 103

Complex Comprehensive Medical-Legal Evaluation

None

$937.50

ML 103

Complex Comprehensive Medical-Legal Evaluation

93 (With Interpreter)

$1,031.25

ML 103

Complex Comprehensive Medical-Legal Evaluation

94 (AME)

$1,171.88

ML 103

Complex Comprehensive Medical-Legal Evaluation

95 (Panel QME)

$937.50

ML 103

Complex Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 94 (AME)

$1,265.63

ML 103

Complex Comprehensive Medical-Legal Evaluation

93 (With Interpreter) + 95 (Panel QME)

$1,031.25

Medical-Legal Reimbursements, Time Based (ML101, ML104, ML105, ML106)

Time in Minutes

Units

No Modifier

Modifier 94 (AME)

Modifier 95 (Panel QME)

15

1

$62.50

$78.13

$62.50

30

2

$125.00

$156.26

$125.00

45

3

$187.50

$234.39

$187.50

60

4

$250.00

$312.52

$250.00

75

5

$312.50

$390.65

$312.50

90

6

$375.00

$468.78

$375.00

105

7

$437.50

$546.91

$437.50

120

8

$500.00

$625.04

$500.00

135

9

$562.50

$703.17

$562.50

150

10

$625.00

$781.30

$625.00

165

11

$687.50

$859.43

$687.50

180

12

$750.00

$937.56

$750.00

195

13

$812.50

$1015.69

$812.50

210

14

$875.00

$1093.82

$875.00

225

15

$937.50

$1171.95

$937.50

240

16

$1000.00

$1250.08

$1,000.00

255

17

$1062.50

$1328.21

$1,062.50

270

18

$1125.00

$1406.34

$1,125.00

285

19

$1187.50

$1484.47

$1,187.50

300

20

$1250.00

$1562.60

$1,250.00

315

21

$1312.50

$1640.73

$1,312.50

330

22

$1375.00

$1718.86

$1,375.00

Other Services

Reimbursement rates for various other services also increased, from just over a single percent, all the way up to a 12.11% increase for CPT code 95851 and a 17.02% jump for CPT code 95852, both for range of motion measurements.

Billing                   Code

Description

 Reimbursement  (Non-Facility)  December 2017

Reimbursement  (Non-Facility)  January 2018

 Reimbursement  Difference

 Percent  Change

90837

Psytx w pt 60 minutes

$166.71

$174.87

$8.16

+4.67%

90875

Psychophysiological therapy

$82.31

$84.79

$2.48

+2.92%

95831

Limb muscle testing manual

$43.81

$46.70

$2.89

+6.19%

95832

Hand muscle testing manual

$43.02

$45.61

$2.59

+5.68%

95834

Body muscle testing manual

$72.73

$76.82

$4.09

+5.32%

95851

Range of motion measurements

$25.40

$28.90

$3.50

+12.11%

 95852

Range of motion measurements

$22.03

$26.55

$4.52

+17.02%

95886

Musc test done w/n test comp

$63.00

$63.74

$.74

+1.16%

96101

Psycho testing by psych/phys

$105.22

$110.60

$5.38

+4.86%

98940

Chiropract manj 1-2 regions

$38.61

$39.61

$1.00

+2.52%

99354

Prolong e&m/psyctx serve o/p

$173.90

$177.39

$3.49

+1.97%

99358

Prolong service w/o contact

$149.40

$150.99

$1.59

+1.05%

99359

Prolong service w/o contact add

$71.96

$72.74

$0.78

+1.07%

 

____________________________________________________________________________

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