2018 Workers’ Comp Reimbursement Cheat Sheet
*Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*
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, click here.
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% |
Get a handle on the OMFS. DaisyBill's Work Comp Wizard includes our exclusive OMFS Calculator, constantly updated to reflect the most current reimbursements. Make billing easier, faster, better. Try the Wizard today!
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