The California Division of Workers’ Compensation (DWC) recently updated the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for workers’ compensation. This update, effective for all dates of service on or after July 1, 2024, adds 130 new procedure codes.
This update ensures that the OMFS is aligned with the relevant 2024 changes in the Medicare payment system, as mandated by California Labor Code Section 5307.1. The DWC made this announcement in a recent communication and posted the order adopting the update on their website.
For DoctorMGT clients, there’s no need for concern or additional actions. We’ve already integrated the new Healthcare Common Procedure Coding System (HCPCS) codes into our billing software, ensuring a seamless transition for all services rendered on or after July 1.
However, for providers not using DoctorMGT or any other Medical billing services California, it’s essential to update your systems to accommodate these new codes starting from July 1.
DWC Newsline Issued June 18, 2024
The update brings the OMFS in line with the relevant 2024 Medicare payment system changes, as California Labor Code Section 5307.1 requires.
Here are the 130 new HCPCS codes adopted by the DWC (and CMS) for the third quarter of 2024. Note that when Medicare does not assign an HCPCS code a Relative Value Unit (RVU), the reimbursement is calculated “By Report” (BR). California Code of Regulations Section 9789.12.4 provides guidelines for appropriate reimbursement amounts for BR codes.
Update: 130 HCPCS Codes Added to Physician Services Fee Schedule
| HCPCS | Modifier | Description | Reimbursement Calculation |
| 0640T | TC | Ncntc ifr spctrsc o/t pad 1 | By Report |
| 0640T | 26 | Ncntc ifr spctrsc o/t pad 1 | By Report |
| 0859T | 26 | Ncntc ifr spctrsc o/t pad ea | By Report |
| 0859T | TC | Ncntc ifr spctrsc o/t pad ea | By Report |
| 0867T | Tpla b9 prst8 hyprplsa>=50ml | By Report | |
| 0868T | 26 | Hi-res gastric ep mapping | By Report |
| 0868T | TC | Hi-res gastric ep mapping | By Report |
| 0868T | Hi-res gastric ep mapping | By Report | |
| 0869T | Njx b1 sub mtrl hw fixj aug | By Report | |
| 0870T | Imp subq prtl ascts pmp sys | By Report | |
| 0871T | Rplcmt subq prtl ascites pmp | By Report | |
| 0872T | Rplcmt ndwllg bldr&prtl cath | By Report | |
| 0873T | Revj subq prtl asct pmp sys | By Report | |
| 0874T | Rmvl pertl ascites pmp sys | By Report | |
| 0875T | Prgrm subq prtl asct pmp sys | By Report | |
| 0876T | TC | Duplex scan hemo fstl lmtd | By Report |
| 0876T | 26 | Duplex scan hemo fstl lmtd | By Report |
| 0876T | Duplex scan hemo fstl lmtd | By Report | |
| 0877T | Augmnt alys ch ct ild w/o ct | By Report | |
| 0878T | Augmnt alys ch ct ild w/ct | By Report | |
| 0879T | Augmnt alys ch ct ild prep | By Report | |
| 0880T | Augmnt alys ch ct ild i&r | By Report | |
| 0881T | Cryotherapy oral cavity | By Report | |
| 0882T | Intraop ther estim pn ue 1st | By Report | |
| 0883T | Intraop ther estim pn ue ea | By Report | |
| 0884T | Esphgsc flx 1st tndsc dilat | By Report | |
| 0885T | Colsc flx 1st tndsc dilat | By Report | |
| 0886T | Sgmdsc flx 1st tndsc dilat | By Report | |
| 0887T | End-tidal ctrl inhaled anes | By Report | |
| 0888T | Histotripsy mal renal tissue | By Report | |
| 0889T | Prsnlz trgt dvl arhfcmrigtbs | By Report | |
| 0890T | Arhfcmrigtbs 1st tx day | By Report | |
| 0891T | Arhfcmrigtbs sbsq tx day | By Report | |
| 0892T | Arhfcmrigtbs sbsq per tx day | By Report | |
| 0893T | 26 | N-invas assmt bld oxygnation | By Report |
| 0893T | TC | N-invas assmt bld oxygnation | By Report |
| 0893T | N-invas assmt bld oxygnation | By Report | |
| 0894T | Cannulation liver allograft | By Report | |
| 0895T | Connj lvr algrft prfu dev 1 | By Report | |
| 0896T | Connj lvr algrft prfu dev ea | By Report | |
| 0897T | TC | N-invas augmnt arrhyt alys | By Report |
| 0897T | N-invas augmnt arrhyt alys | By Report | |
| 0897T | 26 | N-invas augmnt arrhyt alys | By Report |
| 0898T | TC | N-invas prst8 cancer est map | By Report |
| 0898T | 26 | N-invas prst8 cancer est map | By Report |
| 0898T | N-invas prst8 cancer est map | By Report | |
| 0899T | 26 | N-invas deter aqmbf aug cmr | By Report |
| 0899T | N-invas deter aqmbf aug cmr | By Report | |
| 0899T | TC | N-invas deter aqmbf aug cmr | By Report |
| 0900T | 26 | N-invas est aqmbf asstv cmr | By Report |
| 0900T | TC | N-invas est aqmbf asstv cmr | By Report |
| 0900T | N-invas est aqmbf asstv cmr | By Report | |
| 90637 | Vacc qirv mrna 30mcg/.5ml im | By Report | |
| 90638 | Vacc qirv mrna 60mcg/.5ml im | By Report | |
| A2026 | Restrata minimatrix, 5 mg | By Report | |
| A4271 | Home lancing/test cartridges | Section 9789.60 establishes payment conditions | |
| A4438 | Adhesive clip ext ens contr | Section 9789.60 establishes payment conditions | |
| A4564 | Pessary, disposable any type | By Report | |
| A4593 | Neuromod sti sys adj rehab | By Report | |
| A4594 | Neuromod adj rehab mouthpie | By Report | |
| A9293 | Fertility cycl tracking soft | By Report | |
| A9506 | Tc-99m graphite crucible | By Report | |
| G0519 | New pt-cg dyad dem low cmplx | By Report | |
| G0520 | New pt-cg dyad dem mod cmplx | By Report | |
| G0521 | New pt-cg dyad dem hig cmplx | By Report | |
| G0522 | Mgt nw pt dementia low cmplx | By Report | |
| G0523 | Mgt nw pt dem mod-high cmplx | By Report | |
| G0524 | Est pt-cg dyad dem low cmplx | By Report | |
| G0525 | Est pt-cg dyad dem mod cmplx | By Report | |
| G0526 | Est pt-cg dyad dem hig cmplx | By Report | |
| G0527 | Mgt est pt dmentia low cmplx | By Report | |
| G0528 | Mgt est pt dem mod-hi cmplx | By Report | |
| G0529 | In home respite care, 4 hr u | By Report | |
| G0530 | Adult daycare center, 8 hr u | By Report | |
| G0531 | Fclty-based respite, 24 hr u | By Report | |
| G9037 | Intrpro req fr rec phys/qhcp | RVU+GPCI+CF | |
| G9038 | Co-management services | RVU+GPCI+CF | |
| H0051 | Traditional healing service | By Report | |
| J0211 | Inj, nithiodote, 3mg / 125mg | By Report | |
| J0687 | Inj cefazolin (wg crit care) | By Report | |
| J0872 | Daptomycin (xellia) unrefrig | By Report | |
| J0911 | Inst tauro 1.35mg/hep 100u | By Report | |
| J1597 | Inj glycopyrrolate, glyrx-pf | By Report | |
| J1598 | Inj glycopyrrolate fres kabi | By Report | |
| J1748 | Inj, zymfentra, 10 mg | By Report | |
| J2183 | Inj meropenem (wg crit care) | By Report | |
| J2246 | Inj, micafungin (baxter) | By Report | |
| J2267 | Inj, mirikizumab-mrkz, 1 mg | By Report | |
| J2373 | Inj, immphentiv, 20 mcg | By Report | |
| J2468 | Inj, palonosetron (avyxa) | By Report | |
| J2470 | Inj pantoprazole sodium 40mg | By Report | |
| J2471 | Inj pantoprazole(hikma) 40mg | By Report | |
| J3247 | Inj secukinumab intrav 1mg | By Report | |
| J3263 | Inj, toripalimab-tpzi, 1 mg | By Report | |
| J3393 | Inj, betibeglogene autotemce | By Report | |
| J3394 | Inj, lovotibeglogene autotem | By Report | |
| J7171 | Inj, adzynma, 10 iu | By Report | |
| J7355 | Inj travoprost intra impl | By Report | |
| J8611 | Oral methotrexate (jylamvo) | By Report | |
| J8612 | Oral methotrexate (xatmep) | By Report | |
| J9361 | Inj, efbemalenograstim alfa- | By Report | |
| M0224 | Pemivibart infusion | By Report | |
| Q0224 | Inj, pemivibart, 4500 mg | By Report | |
| Q4311 | Acesso, per sq cm | By Report | |
| Q4312 | Acesso ac, per sq cm | By Report | |
| Q4313 | Dermabind fm, per sq cm | By Report | |
| Q4314 | Reeva, per sq cm | By Report | |
| Q4315 | Regenelink amniotic mem allo | By Report | |
| Q4316 | Amchoplast, per sq cm | By Report | |
| Q4317 | Vitograft, per sq cm | By Report | |
| Q4318 | E-graft, per sq cm | By Report | |
| Q4319 | Sanograft, per sq cm | By Report | |
| Q4320 | Pellograft, per sq cm | By Report | |
| Q4321 | Renograft, per sq cm | By Report | |
| Q4322 | Caregraft, per sq cm | By Report | |
| Q4323 | Alloply, per sq cm | By Report | |
| Q4324 | Amniotx, per sq cm | By Report | |
| Q4325 | Acapatch, per sq cm | By Report | |
| Q4326 | Woundplus, per sq cm | By Report | |
| Q4327 | Duoamnion, per sq cm | By Report | |
| Q4328 | Most, per sq cm | By Report | |
| Q4329 | Singlay, per sq cm | By Report | |
| Q4330 | Total, per sq cm | By Report | |
| Q4331 | Axolotl graft, per sq cm | By Report | |
| Q4332 | Axolotl dualgraft, per sq cm | By Report | |
| Q4333 | Ardeograft, per sq cm | By Report | |
| Q5137 | Inj, wezlana, sub cu, 1 mg | By Report | |
| Q5138 | Inj, wezlana, iv, 1 mg | By Report | |
| S4988 | Penile contractur devic manu | By Report | |
| S9002 | Intra-vag motion sens biofk | By Report |
However, Medical Billing and Coding Services California through DoctorMGT will automatically reflect the latest reimbursement rates, ensuring accuracy and compliance. If you have any questions regarding this fee schedule update, please use the chat function at the bottom right of this screen or email our experts at [email protected].
By staying up-to-date with these changes, you can ensure your practice remains compliant and efficient. Don’t hesitate to reach out if you need any assistance with this transition.
Your efficiency and compliance are our top priorities at DoctorMGT.