Are you aware of the new update for CA OMFS: Physician Services (Q3 2024)?

Are you aware of the new update for CA OMFS: Physician Services (Q3 2024)?

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

HCPCSModifierDescriptionReimbursement Calculation
0640TTCNcntc ifr spctrsc o/t pad 1By Report
0640T26Ncntc ifr spctrsc o/t pad 1By Report
0859T26Ncntc ifr spctrsc o/t pad eaBy Report
0859TTCNcntc ifr spctrsc o/t pad eaBy Report
0867T Tpla b9 prst8 hyprplsa>=50mlBy Report
0868T26Hi-res gastric ep mappingBy Report
0868TTCHi-res gastric ep mappingBy Report
0868T Hi-res gastric ep mappingBy Report
0869T Njx b1 sub mtrl hw fixj augBy Report
0870T Imp subq prtl ascts pmp sysBy Report
0871T Rplcmt subq prtl ascites pmpBy Report
0872T Rplcmt ndwllg bldr&prtl cathBy Report
0873T Revj subq prtl asct pmp sysBy Report
0874T Rmvl pertl ascites pmp sysBy Report
0875T Prgrm subq prtl asct pmp sysBy Report
0876TTCDuplex scan hemo fstl lmtdBy Report
0876T26Duplex scan hemo fstl lmtdBy Report
0876T Duplex scan hemo fstl lmtdBy Report
0877T Augmnt alys ch ct ild w/o ctBy Report
0878T Augmnt alys ch ct ild w/ctBy Report
0879T Augmnt alys ch ct ild prepBy Report
0880T Augmnt alys ch ct ild i&rBy Report
0881T Cryotherapy oral cavityBy Report
0882T Intraop ther estim pn ue 1stBy Report
0883T Intraop ther estim pn ue eaBy Report
0884T Esphgsc flx 1st tndsc dilatBy Report
0885T Colsc flx 1st tndsc dilatBy Report
0886T Sgmdsc flx 1st tndsc dilatBy Report
0887T End-tidal ctrl inhaled anesBy Report
0888T Histotripsy mal renal tissueBy Report
0889T Prsnlz trgt dvl arhfcmrigtbsBy Report
0890T Arhfcmrigtbs 1st tx dayBy Report
0891T Arhfcmrigtbs sbsq tx dayBy Report
0892T Arhfcmrigtbs sbsq per tx dayBy Report
0893T26N-invas assmt bld oxygnationBy Report
0893TTCN-invas assmt bld oxygnationBy Report
0893T N-invas assmt bld oxygnationBy Report
0894T Cannulation liver allograftBy Report
0895T Connj lvr algrft prfu dev 1By Report
0896T Connj lvr algrft prfu dev eaBy Report
0897TTCN-invas augmnt arrhyt alysBy Report
0897T N-invas augmnt arrhyt alysBy Report
0897T26N-invas augmnt arrhyt alysBy Report
0898TTCN-invas prst8 cancer est mapBy Report
0898T26N-invas prst8 cancer est mapBy Report
0898T N-invas prst8 cancer est mapBy Report
0899T26N-invas deter aqmbf aug cmrBy Report
0899T N-invas deter aqmbf aug cmrBy Report
0899TTCN-invas deter aqmbf aug cmrBy Report
0900T26N-invas est aqmbf asstv cmrBy Report
0900TTCN-invas est aqmbf asstv cmrBy Report
0900T N-invas est aqmbf asstv cmrBy Report
90637 Vacc qirv mrna 30mcg/.5ml imBy Report
90638 Vacc qirv mrna 60mcg/.5ml imBy Report
A2026 Restrata minimatrix, 5 mgBy Report
A4271 Home lancing/test cartridgesSection 9789.60 establishes payment conditions
A4438 Adhesive clip ext ens contrSection 9789.60 establishes payment conditions
A4564 Pessary, disposable any typeBy Report
A4593 Neuromod sti sys adj rehabBy Report
A4594 Neuromod adj rehab mouthpieBy Report
A9293 Fertility cycl tracking softBy Report
A9506 Tc-99m graphite crucibleBy Report
G0519 New pt-cg dyad dem low cmplxBy Report
G0520 New pt-cg dyad dem mod cmplxBy Report
G0521 New pt-cg dyad dem hig cmplxBy Report
G0522 Mgt nw pt dementia low cmplxBy Report
G0523 Mgt nw pt dem mod-high cmplxBy Report
G0524 Est pt-cg dyad dem low cmplxBy Report
G0525 Est pt-cg dyad dem mod cmplxBy Report
G0526 Est pt-cg dyad dem hig cmplxBy Report
G0527 Mgt est pt dmentia low cmplxBy Report
G0528 Mgt est pt dem mod-hi cmplxBy Report
G0529 In home respite care, 4 hr uBy Report
G0530 Adult daycare center, 8 hr uBy Report
G0531 Fclty-based respite, 24 hr uBy Report
G9037 Intrpro req fr rec phys/qhcpRVU+GPCI+CF
G9038 Co-management servicesRVU+GPCI+CF
H0051 Traditional healing serviceBy Report
J0211 Inj, nithiodote, 3mg / 125mgBy Report
J0687 Inj cefazolin (wg crit care)By Report
J0872 Daptomycin (xellia) unrefrigBy Report
J0911 Inst tauro 1.35mg/hep 100uBy Report
J1597 Inj glycopyrrolate, glyrx-pfBy Report
J1598 Inj glycopyrrolate fres kabiBy Report
J1748 Inj, zymfentra, 10 mgBy Report
J2183 Inj meropenem (wg crit care)By Report
J2246 Inj, micafungin (baxter)By Report
J2267 Inj, mirikizumab-mrkz, 1 mgBy Report
J2373 Inj, immphentiv, 20 mcgBy Report
J2468 Inj, palonosetron (avyxa)By Report
J2470 Inj pantoprazole sodium 40mgBy Report
J2471 Inj pantoprazole(hikma) 40mgBy Report
J3247 Inj secukinumab intrav 1mgBy Report
J3263 Inj, toripalimab-tpzi, 1 mgBy Report
J3393 Inj, betibeglogene autotemceBy Report
J3394 Inj, lovotibeglogene autotemBy Report
J7171 Inj, adzynma, 10 iuBy Report
J7355 Inj travoprost intra implBy Report
J8611 Oral methotrexate (jylamvo)By Report
J8612 Oral methotrexate (xatmep)By Report
J9361 Inj, efbemalenograstim alfa-By Report
M0224 Pemivibart infusionBy Report
Q0224 Inj, pemivibart, 4500 mgBy Report
Q4311 Acesso, per sq cmBy Report
Q4312 Acesso ac, per sq cmBy Report
Q4313 Dermabind fm, per sq cmBy Report
Q4314 Reeva, per sq cmBy Report
Q4315 Regenelink amniotic mem alloBy Report
Q4316 Amchoplast, per sq cmBy Report
Q4317 Vitograft, per sq cmBy Report
Q4318 E-graft, per sq cmBy Report
Q4319 Sanograft, per sq cmBy Report
Q4320 Pellograft, per sq cmBy Report
Q4321 Renograft, per sq cmBy Report
Q4322 Caregraft, per sq cmBy Report
Q4323 Alloply, per sq cmBy Report
Q4324 Amniotx, per sq cmBy Report
Q4325 Acapatch, per sq cmBy Report
Q4326 Woundplus, per sq cmBy Report
Q4327 Duoamnion, per sq cmBy Report
Q4328 Most, per sq cmBy Report
Q4329 Singlay, per sq cmBy Report
Q4330 Total, per sq cmBy Report
Q4331 Axolotl graft, per sq cmBy Report
Q4332 Axolotl dualgraft, per sq cmBy Report
Q4333 Ardeograft, per sq cmBy Report
Q5137 Inj, wezlana, sub cu, 1 mgBy Report
Q5138 Inj, wezlana, iv, 1 mgBy Report
S4988 Penile contractur devic manuBy Report
S9002 Intra-vag motion sens biofkBy 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.