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California Division of Workers’ Compensation Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services)
By Lonce Lamonte and Newsline from the CA DIR's Division of Workers' Compensation - June 24, 2020

The Division of Workers’ Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.

The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the following Medicare changes:

July 2020 Quarterly Update

The following OMFS adjustments are effective for services rendered on or after July 1, 2020:

  • CMS’ Medicare National Physician Fee Schedule Relative Value File RVU20C July 1, 2020 quarterly update
  • National Correct Coding Initiative Practitioner Procedure to Procedure (PTP) Edits July 1, 2020 quarterly update
  • National Correct Coding Initiative Medically Unlikely Edits July 1, 2020 quarterly update (excluding MUE “0” value codes)
  • CMS’ Zip Code to Carrier Locality files July 1, 2020 quarterly update, for Geographic Practice Cost Index (GPCI) locality mapping

Revision to April 2020 Quarterly Update:

  • National Correct Coding Initiative Medically Unlikely Edits April 1, 2020 quarterly update file, “Practitioner Services MUE Table - Effective 04-01-2020 (ZIP),” (excluding MUE “0” value codes) is replaced by “Practitioner Services MUE Table - Replacement Effective 04-01-2020 (ZIP),” (excluding MUE “0” value codes).

The replacement Practitioner Services MUE Table is retroactive to April 1, 2020.

The updated regulation text includes the June 15 monthly Medi-Cal Rates file update for physician-administered drugs, biologicals, vaccines or blood products, the April 1, 2020 replacement Practitioner Services MUE Table as well as the July 1, 2020 quarterly updates.

The order adopting the above OMFS adjustments can be found on the DWC website.

# # #

lonce@adjustercom.com, Lonce Lamonte, journalist and editor of adjustercom with the California Division of Workers' Compensation

 
 

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