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California Division of Worker’s Compensation Posts Adjustments to Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services
By Lonce Lamonte and the DWC Newsline - February 10, 2021

The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2021 changes in the Medicare payment system as required by Labor Code section 5307.1. The Administrative Director update order adopting the OMFS adjustments is effective for services rendered on or after March 1, 2021. Some of the significant changes include the following.

  • Revisions relating to Evaluation and Management (E&M) services for office visits for new and established patients
    • 1995 and 1997 Evaluation and Management Documentation Guidelines are no longer used
    • American Medical Association’s Current Procedural Terminology (CPT) E&M office visit code descriptors and guidelines have been revised
    • Level of E&M office visit service is reported using either level of medical decision making or total time
    • First level new patient office visit code CPT 99201 has been eliminated
    • Medicare Prolonged Service Code HCPCS G2212 is adopted for use in place of CPT code 99417 for prolonged E&M service provided on the date of service where the level of service is selected based upon time
  • Updated relative value units
  • Updated conversion factors
  • Updated Table A – anesthesia conversion factors adjusted for Geographic Practice Cost Index
  • Updated telehealth list

The Order, effective for services rendered on or after March 1, 2021, and related documents can be found at the DWC OMFS physician fee schedule webpage.

 

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

 
 

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