Preparing your practice for the changes already hitting claims
Waqas Alee, CEO, Doctor Management Services
California’s Q3 2026 HCPCS update went into effect quietly, but the denials it’s triggering are anything but quiet. Several codes that workers’ comp billers have relied on for years were revised or retired under the updated OMFS schedule, and payers didn’t wait around to start enforcing it.
DoctorMGT sat down with CEO Waqas Alee to break down exactly what changed why this denial is worse than previous updates, and what a practice must do now, before the next billing cycle is over to avoid losing revenue.
DoctorMGT: Let’s start broad. What actually changed on the fee schedule, and why is this update generating more denials than usual?
Mr. Alee: This wasn’t a minor housekeeping update. The Division of Workers’ Compensation revised a meaningful chunk of the HCPCS codes tied to the Official Medical Fee Schedule, and a handful of codes that were routine last quarter simply don’t exist in their old form anymore.
The one thing that makes this cycle even worse than previous ones is that many practices are still getting paid according to the same code they used back in June and payers have already changed their systems to refuse to pay that code. The days between the date of the schedule change and when practices recognize it are where denials are accumulating.
DoctorMGT: Can you give us a sense of scale? Is this affecting most WC billers, or a smaller subset?
Mr. Alee: That’s very much dependent on the specialty. A large portion of the retired and revised codes falls in the high volume of physical medicine and DME-adjacent coding practices, making these the most disrupted. There were clients who had one hit code that was 10 to 15 per cent of their WC claim volume for the month. The amount is no rounding error. If it is not detected for a complete billing cycle, that’s a cash flow event!
DoctorMGT: What should a practice actually do to check their exposure?
Mr. Alee: Start narrow. Pull your top twenty or thirty most-billed workers’ comp codes, and compare them with the current OMFS schedule; don’t compare with your EMR’s code library, since they don’t always update in real time. If there was a change in the code, review if there has been a change in the description or reimbursement amount. If it is a retired item, look up its replacement prior to making a second claim with it.
DoctorMGT: Beyond the code-level check, are there workflow changes practices should be making?
Mr. Alee: Yes. The bigger issue isn’t any single code; it’s that most practices don’t have a standing process for catching fee schedule changes when they happen. They learn reactively, through a denial. I would suggest having someone (even a part-time person) that keep an eye on DWC and OMFS updates quarterly, like keeping an eye on updates to CPT and ICD-10 each year. The billing of workers’ comp follows its own regulatory timeline, and when practices delay coding the comp claim until after the general coding update, that’s how they end up caught off guard.
DoctorMGT: For claims that already went out with an outdated code, what’s the right move?
Mr. Alee: Don’t wait for the denial to explain itself. If you’ve confirmed a code was impacted by the Q3 update, and have submitted a claim for it, submit or correct the claim proactively, don’t wait for the payer to review. Existing workers’ comp claims can take longer to clear than regular commercial claims, and the delay from a fee-schedule denial isn’t going to help you get any more time back.
DoctorMGT: Are there specific code categories you’d flag as highest risk right now?
Mr. Alee: Physical medicine and rehab codes, multiple DME categories/several codes for evaluation of injury codes. If there is something that a practice bills regularly that has not been manually checked for changes against the new schedule, it is a risk until it is confirmed.
DoctorMGT: Last question, what’s the takeaway for a practice reading this who hasn’t checked any of this yet?
Mr. Alee: Don’t assume your billing software caught it. Fee schedule updates are exactly the kind of change that slips past automated systems until someone manually flags it.
Check your top codes against the current OMFS schedule this week, not after your next round of denials shows up. The practices that stay ahead of these updates aren’t doing anything complicated. They’re just not waiting for the payer to tell them something changed.
About Waqas Alee
Mr. Alee is the CEO of Doctor Management Services, a medical billing and practice management company based in Anaheim, California, specializing in workers’ compensation and personal injury lien-based billing. He works closely with providers navigating California’s fee schedule and regulatory landscape, with a focus on building billing workflows that catch payer and coding changes before they turn into denied claims.
