Official Medical Fee Schedule (OMFS)
The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.
If you have questions regarding the Official Medical Fee Schedule (OMFS) email us at DWCFeeSchedule@dir.ca.gov.
Topics covered in the OMFS include:
Ambulance fees
Durable medical equipment, prosthetics, orthotics and supplies
Inpatient hospital
Outpatient hospital
Pathology and clinical laboratory
Pharmaceuticals
Physician services
Ambulance fees
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 1, 2013 use:
- Order of the acting administrative director of the Division of Workers' Compensation, Mar. 19, 2013
version 
version - Regulation sections 9789.70 & 9789.110 & 9789.111 version version
- Centers for Medicare and Medicaid Services:
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after March 1, 2012 use:
Order of the administrative director of the Division of Workers' Compensation, Feb. 8, 2012 version version
- Centers for Medicare and Medicaid Services CY 2012 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
- ambfspuf_2012 txt version
- ambfspuf_2012
version - Ambo_PUF_CY2012_fact_sheet version
- PUF2012_index version
- For reference: CMS Manual System Transmittal No. 2310 version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2011 use:
- Order of the administrative director of the Division of Workers' Compensation, Jan. 27, 2011 version version
- Centers for Medicare and Medicaid Services CY 2011 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
- ambfspuf_2011_MMEA_Rev_v2.0 txt version
- ambfspuf_2011_MMEA_Rev_v2.0 version
- Ambo_PUF_CY2011_fact_sheet_v2.0 version
- PUF2011_index version
- For reference: CMS Manual System Transmittal No. 2104 version
In addition to the regulations for services provided on or after Jan. 2, 2004, use:
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2009 use:
- Order of the administrative director of the Division of Workers' Compensation, Dec. 29, 2008
version 
version - Centers for Medicare and Medicaid Services CY 2009 Ambulance Fee Schedule Public Use File, which contains the following electronic files:
- [SUPERSEDED – DO NOT USE: Order of the administrative director of the Division of Workers' Compensation, Dec.11, 2008 version version]
- For reference only, Centers for Medicare and Medicaid Services Sept. 18, 2008, Executive Guidance No. 0531, Change Request 6113 to Pub. 100-04 version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after July 1, 2008 use:
- Order of the administrative director of the Division of Workers' Compensation, Dec. 8, 2008 version version
Centers for Medicare and Medicaid Services 2008 Public Use File, as revised Oct. 1, 2008, which contains the following electronic files:
- 2008 Ambulance Fee Schedule PUF MIPPA Update. version version
- 10-08_PUF 2008_MIPPA_Update index. version
- CY 2008 fact sheet update version
- The portion of the regulation of Centers for Medicare and Medicaid Services (CMS) proposed final rule entitled “Subpart H—Fee Schedule For Ambulance Services,” appearing as a part of the proposed final rule of the CMS entitled, “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; E-Prescribing Exemption for Computer-Generated Facsimile Transmissions; and Payment for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” filed Nov. 19, 2008, and commencing at Vol. 73 FR 69725. version
Centers for Medicare and Medicaid Services Zip Code to Carrier Locality File, as revised Nov. 13, 2008 which contains the following electronic files:
- ZIP5_JAN09 version
- ZIP5_JAN09 txt version
- ZIP5lyout_jan09 txt version
- ZIP9_JAN09 txt version
- ZIP9lyout txt version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 7, 2008 use:
- Centers for Medicare and Medicaid Services 2008 Public Use File, which contains the following electronic files:
- 2008 Ambulance Fee Schedule PUF version version
- Index of Ambulance Fee Schedule public use file (Jan - Dec 2008) index version
- CY Ambulance Fee Schedule public use file fact sheet version
- 508 Compliant Version of 2008 Ambulance Fee Schedule PUF version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2008 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Portions of Regulation of Centers for Medicare and Medicaid Services final rule entitled, "C. Ambulance Inflation Factor (AIF) for CY 2008", appearing as a part of the final rule of The Centers for Medicare and Medicaid Services entitled, "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, and Other Part B Payment Policies for CY 2008; Revisions to the Payment Policies of Ambulance Services Under the Ambulance Fee Schedule for CY 2008; and the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions" (CMS-1385-FC), commencing at Vol. 72 FR 66221 and ending at 66578, filed November 27,2007. version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Feb. 1, 2007 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Portions of Regulation of Centers for Medicare and Medicaid Services final rule entitled, "Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; and Ambulance Inflation Factor Update for CY 2007" (CMS-1321-FC and CMS-1317-F), commencing at Vol. 71 FR 69623, filed Dec.1, 2006. version
- Centers for Medicare and Medicaid Services electronic files:
The CY 2007 Public Use File
version version
MSAvCBSA version version
ZIPlyout_1 version version
ZPLC0107V2 version version
ZPLC0107V2 version txt version
- Order of the administrative director of the Division of Workers' Compensation version version
- Portion of Regulation of Centers for Medicare and Medicaid Services, "D. Ambulance Inflation Factor (AIF) for 2007", appearing at page 69719 of Vol. 71, Federal Register, as a part of the rule entitled, "Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; and Ambulance Inflation Factor Update for CY 2007" (CMS-1321-FC and CMS-1317-F), commencing at Vol. 71 FR 69623, filed Dec.1, 2006. version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2006 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Centers for Medicare and Medicaid Services electronic file electronic file "Jan20052-17-05" version version
- Regulation of Centers for Medicare and Medicaid Services entitled "Medicare Program; Coverage and payment of ambulance services; inflation update for CY 2006" (CMS-1294-N) filed Nov.23, 2005. (Federal register Vol. 70 No. 226, Nov. 25, 2005, Vol. 70 FR 71163) version
In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Sept. 8, 2005 through Dec. 31, 2005 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Centers for Medicare and Medicaid Services electronic file electronic file "Jan20052-17-05" version version
- Centers for Medicare and Medicaid Services document entitled "Medicare Program; Coverage and payment of ambulance service; Recalibration of conversion factor; inflation update for CY 2005" (CMS-1267-N). (Federal register Vol. 69 No. 219, Nov. 15, 2004, Vol. 69 FR 66918) version
Durable medical equipment, prosthetics, orthotics and supplies
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2013 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after January 1, 2013 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2012 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2012 use:
Workers' compensation durable medical equipment, prosthetics, orthotics, and supplies fee schedule – Physician dispensed devices
Legislation that became effective on January 1, 2012 places new caps on “dangerous devices” dispensed by physicians. These new caps are contained in Labor Code section 5307.1.
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2011, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2011, use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Order of the administrative director of the Division of Workers' Compensation version version
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2010, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2010, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2010, use:
- Order of the administrative director of the Division of Workers' Compensation version version
- [SUPERSEDED – DO NOT USE: Order of the administrative director of the Division of Workers' Compensation version version
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2009, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2009, use:
- Order of the administrative director of the Division of Workers' Compensation version version
- [SUPERSEDED – DO NOT USE: Order of the administrative director of the Division of Workers' Compensation version version]
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 7, 2008, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2008, use:
- Order of the administrative director of the Division of Workers' Compensation version version
- [SUPERSEDED – DO NOT USE: Order of the administrative director of the Division of Workers' Compensation version version]
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2007, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2007, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 11, 2007, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 3, 2007, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 5, 2006, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2007, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 13, 2006, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 15, 2006, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2006, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2006, use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 15, 2006 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 15, 2005 please use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Sept. 1, 2005 use:
Inpatient hospital
For inpatient hospital discharges on or after Mar. 15, 2013 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.20 – 9789.25) version version
- Regulation effective Mar. 15, 2013 (sections 9789.20 – 9789.25) version version
- Regulation effective Mar. 15, 2013 (section 9789.23) version version
- Regulation effective Mar. 15, 2013 (section 9789.24) version version
For inpatient hospital discharges on or after Jan. 1, 2013 use:
- Regulation effective Jan. 1, 2013 (sections 9789.20, 9789.21, 9789.22, and 9789.25) version version
- Regulation effective Dec. 1, 2011 (section 9789.23) version version
- Regulation effective Dec. 1, 2011 (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2011 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.21 - 9789.24) version version
- Regulation effective Jul. 1, 2004 (section 9789.20, reprinted) version version
- Regulation effective Dec. 1, 2011 (section 9789.21) version version
- Regulation effective Dec. 1, 2011 (section 9789.22) version version
- Regulation effective Dec. 1, 2011 (section 9789.23) version version
- Regulation effective Dec. 1, 2011 (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for hospital discharges from Monrovia Memorial Hospital on or after May 1, 2009 use:
- Order of the administrative director of the Division of Workers' Compensation version version
In accordance with Monrovia Memorial Hospital’s request and CMS’ approval, Monrovia Memorial Hospital voluntarily terminated their CMS certification number 050762 (acute care hospital) effective April 30, 2009, and became a long term acute care hospital (LTCH) CMS certification number 052054 effective as of May 1, 2009. The Order of the administrative director removes Monrovia Memorial Hospital listed as CMS provider number 050762 from Title 8, California Code of Regulations section 9789.23 for discharges on or after May 1, 2009.
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2011 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.21 - 9789.24) version version
- Regulation effective Mar. 1, 2011 (section 9789.21) version version
- Regulation effective Mar. 1, 2011 (section 9789.22) version version
- Adjustment to Inpatient Hospital Fee Schedule to conform to August 16, 2010 final rule and correction to the final rule of October 1, 2010 changes in the Medicare payment system - hospital cost to charge ratios, hospital specific outliers, and hospital composite factors (section 9789.23) version version
- Adjustment to Inpatient Hospital Fee Schedule to conform to August 16, 2010 final rule and correction to the final rule of October 1, 2010 changes in the Medicare payment system – Medicare severity diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2009 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.20 - 9789.24) version version
- Regulation effective Dec. 1, 2009 (section 9789.21) version version
- Regulation effective Dec. 1, 2009 (section 9789.22) version version
- Adjustment to Inpatient Hospital Fee Schedule to conform to August 27, 2009 final rule and correction to the final rule of October 7, 2009 changes in the Medicare payment system - hospital cost to charge ratios, hospital specific outliers, and hospital composite factors (section 9789.23) version version
- Adjustment to Inpatient Hospital Fee Schedule to conform to August 27, 2009 final rule and correction to the final rule of October 7, 2009 changes in the Medicare payment system – medicare severity diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2008 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Regulation effective Dec. 1, 2008 (Section 9789.23) version version, is adjusted only as to listed providers, to conform to notice to the final rule published on Dec. 3, 2008 in the Federal Register (Vol. 73 FR 73656) and is entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Fiscal Year 2009 Wage Index Changes Following Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice” (CMS-1390-N2)
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24) version version
- Regulation effective Dec. 1, 2008 (section 9789.22) version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to the Medicare FY09 update to the inpatient prospective payment system published on Aug. 19, 2008 in the Federal Register (Vol. 73 FR 48434) and is entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals Final Rules” (CMS-1390-F; CMS-1531-IFC1; CMS-1531-IFC2; CMS-1385-F4), the correction to the final rule published on Oct. 3, 2008, in the Federal Register (Vol. 73 FR 57541), and is entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals; Correction” (CMS-1390-CN; CMS-1531-CN; CMS-1385-CN2), and the notice to the final rule published on Oct. 3, 2008 in the Federal Register (Vol. 73, FR 57888), entitled, “Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Final Fiscal Year 2009 Wage Indices and Payment Rates Including Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice” (CMS-1390-N) version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to the Medicare FY09 update to the inpatient prospective payment system published on Aug.19, 2008 in the Federal Register (Vol. 73 FR 48434) and is entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals Final Rules” (CMS-1390-F; CMS-1531-IFC1; CMS-1531-IFC2; CMS-1385-F4), the correction to the final rule published on Oct. 3, 2008, in the Federal Register (Vol. 73 FR 57541), and is entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate Medical Education in Certain Emergency Situations; Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Updates to the Long-Term Care Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals; and Collection of Information Regarding Financial Relationships Between Hospitals; Correction” (CMS-1390-CN; CMS-1531-CN; CMS-1385-CN2), and the notice to the final rule published on Oct. 3, 2008 in the Federal Register (Vol. 73, FR 57888), entitled, “Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Final Fiscal Year 2009 Wage Indices and Payment Rates Including Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008; Notice” (CMS-1390-N) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Jan. 1, 2008 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24) version version
- Regulation effective Jan. 1, 2008 (section 9789.22) version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to the Medicare FY08 update to the inpatient prospective payment system published on Aug. 22, 2007 in the Federal Register (Vol. 72 FR 47130) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule" (CMS-1533-FC), a correction to the final rule published on Oct. 10, 2007, in the Federal Register (Vol. 72 FR 57634) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN2), a second correction to the final rule published on November 6, 2007, in the Federal Register (Vol. 72 FR 62585) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN3), and a notice to the final rule published on Nov. 27, 2007 in the Federal Register (Vol. 72, No. 227, FR 66580) entitled "Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs; Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals" (CMS-1392-FC, CMS-1533-F2, and CMS-1531-IFC2) version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to the Medicare FY08 update to the inpatient prospective payment system published on Aug. 22, 2007 in the Federal Register (Vol. 72 FR 47130) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Final Rule" (CMS-1533-FC), a correction to the final rule published on Oct. 10, 2007, in the Federal Register (Vol. 72 FR 57634) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN2), a second correction to the final rule published on Nov. 6, 2007, in the Federal Register (Vol. 72 FR 62585) entitled "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction" (CMS-1533-CN3), and a notice to the final rule published on November 27, 2007 in the Federal Register (Vol. 72, No. 227, FR 66580) entitled "Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs; Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals" (CMS-1392-FC, CMS-1533-F2, and CMS-1531-IFC2) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after April 1, 2007 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.23, hospital cost to charge ratios, hospital specific outliers, and hospital composite factors, to conform to CMS' notice of March 23, 2007, published in the Federal Register, Vol. 72, No. 56, FR 13799, entitled, "Medicare Program; Extension of Certain Hospital Wage Index Reclassifications" (CMS-1384-N) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Adjustment to Inpatient Hospital Fee Schedule section 9789.24, diagnostic related groups, relative weights, geometric mean length of stay, to conform to CMS' correction of notice of March 23, 2007, published in Federal Register, Vol. 72, No. 56, FR 13798, entitled, "Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; Corrections" (CMS-1488-CN3)
version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2007 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Regulation effective March 1, 2007 (section 9789.22) version version
- Regulation effective March 1, 2007 (section 9789.24 - diagnostic related groups, relative weights, geometric mean length of stay) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
version version
- Regulation effective Dec. 1, 2006 (section 9789.22) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 18, 2006 final rule and additional notice of Oct. 11, 2006 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 18, 2006 final rule and additional notice of Oct. 11, 2006 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2005 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
version version
- Regulation effective Dec. 1, 2005 (section 9789.22) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 12, 2005 final rule and correction notice of Sept. 30, 2005 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 12, 2005 final rule and correction notice of Sept. 30, 2005 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after July 15, 2005 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations (sections 9789.22 - 9789.24)
version version - Regulation effective July 15, 2005 (section 9789.22(i 2 A)) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 11, 2004 final rule and correction notices of the Oct. 7, 2004 and Dec. 30, 2004 changes in the Medicare payment system - Composite rate, hospital specific outlier threshold and cost to charge ratio - (section 9789.23) version version
- Revised adjustment to Inpatient Hospital Fee Schedule to conform to Aug. 11, 2004 final rule and correction notices of the Oct. 7, 2004 and Dec. 30, 2004 changes in the Medicare payment system - diagnostic related groups, relative weights, geometric mean length of stay (section 9789.24) version version
In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Nov. 29, 2004 use:
- Order of the administrative director of the Division of Workers' Compensation version
- Explanation of changes to Title 8, California Code of Regulations, section 9789.23 version version
- Revised adjustment to Inpatient Hospital Fee Schedule to Conform to the Oct. 1, 2004 changes in the Medicare payment system - Composite Rate,
Outpatient hospital
List of facilities electing to be paid under the high cost outlier methodology
For hospital outpatient and ambulatory surgical center services rendered on or after Apr. 1, 2013 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30 through 9789.39 version version
- Regulation effective Apr. 1, 2013 (sections 9789.30 – 9789.39) version version
- Regulation effective Apr. 1, 2013 (section 9789.34) version version
- Regulation effective Apr. 1, 2013 (section 9789.35) version version
For hospital outpatient departments and ambulatory surgical centers services rendered on or after Jan. 1, 2013 use:
- Regulation effective January 1, 2013 (Sections 9789.30, 9789.31, 9789.32, 9789.33, 9789.36, 9789.37, 9789.38 and 9789.39) version version
- Regulation effective Mar. 1, 2012 (Section 9789.34) version version
- Regulation effective Mar. 1, 2012 (Section 9789.35) version version
In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sep. 1, 2012 use:
- Order of the administrative director version version
- Regulation effective Sep. 1, 2012 (Section 9789.30) version version
- Regulation effective Sep. 1, 2012 (Section 9789.31) version version
- Regulation effective Mar. 1, 2009 (Section 9789.32) version version
- Regulation effective Mar. 1, 2012 (Section 9789.33) version version
- Regulation effective Mar. 1, 2012 (Section 9789.34) version version
- Regulation effective Mar. 1, 2012 (Section 9789.35) version version
- Regulation effective Jul. 1, 2004 (Section 9789.36) version version
- Regulation effective Jul. 1, 2004 (Section 9789.37) version version
- Regulation effective Mar. 1, 2012 (Section 9789.38) version version
In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Mar. 1, 2012 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 version version
- Regulation effective Mar. 1, 2012 (Section 9789.30) version version
- Regulation effective Mar. 1, 2012 (Section 9789.31) version version
- Regulation effective Mar. 1, 2009 (Section 9789.32) version version
- Regulation effective Mar. 1, 2012 (Section 9789.33) version version
- Regulation effective Mar. 1, 2012 (Section 9789.34) version version
- Regulation effective Mar. 1, 2012 (Section 9789.35) version version
- Regulation effective Jul. 1, 2004 (Section 9789.36) version version
- Regulation effective Jul. 1, 2004 (Section 9789.37) version version
- Regulation effective Mar. 1, 2012 (Section 9789.38) version version
In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sept. 15, 2011 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 version version
- Regulation effective Sept. 15, 2011 (Section 9789.30) version version
- Regulation effective Sept. 15, 2011 (Section 9789.31) version version
- Regulation (reprinted) (Section 9789.32) version version
- Regulation effective Sept. 15, 2011 (Section 9789.33) version version
- Regulation effective Sept. 15, 2011 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective Sept. 15, 2011 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
- Regulation (reprinted) (Section 9789.36) version version
- Regulation (reprinted) (Section 9789.37) version version
- Regulation effective Sept. 15, 2011 (Section 9789.38) version version
In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Apr. 15, 2010 use:
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 version version
- Regulation effective Apr. 15, 2010 (Section 9789.30) version version
- Regulation effective Apr. 15, 2010 (Section 9789.31) version version
- Regulation (reprinted) (Section 9789.32) version version
- Regulation effective Apr. 15, 2010 (Section 9789.33) version version
- Regulation effective Apr. 15, 2010 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective Apr. 15, 2010 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
- Regulation effective Apr. 15, 2010 (Section 9789.38) version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2009 use:
- Order of the acting chief deputy administrative director of the Division of Workers' Compensation version version
- Regulation effective March 1, 2009 (Section 9789.31) version version
- Order of the acting administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.32, 9789.33, 9789.34, and 9789.35 version version
- [SUPERSEDED - DO NOT USE: Regulation effective March 1, 2009 (Section 9789.31) version version ]
- Regulation effective March 1, 2009 (Section 9789.32) version version
- Regulation effective March 1, 2009 (Section 9789.33) version version
- Regulation effective March 1, 2009 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective March 1, 2009 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2008 use:
- Order of the administrative director of the Division of Workers' Compensation
version
version
- Regulation effective March 1, 2008 (Section 9789.31) version version
- Order of the administrative director of the Division of Workers' Compensation version version
- Regulation effective March 1, 2008 (Section 9789.32) version version
- Regulation effective March 1, 2008 (Section 9789.33) version version
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.34, and 9789.35 version version
- Regulation effective March 1, 2008 (Section 9789.30) version version
- [SUPERSEDED – DO NOT USE: Regulation effective March 1, 2008 (Section 9789.31) version version]
- Regulation effective March 1, 2008 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective March 1, 2008 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after April 1, 2007 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Section 9789.35 - table B - Hospital specific wage index and wage adjusted conversion factor is adjusted to conform to CMS' notice of March 23, 2007, published in the Federal Register, Vol. 72, No. 56, FR 13799, entitled, "Medicare Program; Extension of Certain Hospital Wage Index Reclassifications" (CMS-1384-N) version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2007 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.34, and 9789.35 version version
- Regulation effective March 1, 2007 (Section 9789.31) version version
- Regulation effective March 1, 2007 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective March 1, 2007 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Feb. 15, 2006 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31 and 9789.33 - 9789.35 version version
- Regulation effective Feb. 15, 2006 (Section 9789.30) version version
- Regulation effective Feb. 15, 2006 (Section 9789.31) version version
- Regulation effective Feb. 15, 2006 (Section 9789.33) version version
- Regulation effective Feb. 15, 2006 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor version version
- Regulation effective Feb. 15, 2006 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor version version
In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after July 15, 2005 use:
- Order of the administrative director of the Division of Workers' Compensation version version
- Explanation of changes to Title 8, California Code of Regulations, sections 9789.31 and 9789.33 - 9789.35 version version
- Regulation effective July 15, 2005 (Section 9789.31) version version
- Regulation effective July 15, 2005 (Section 9789.33) version version
- Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - County specific wage index and wage adjusted conversion factor (section 9789.34 - table A) version version
- Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - Hospital specific wage index and wage adjusted conversion factor (section 9789.35 - table B) version version
Pathology and clinical laboratory
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2013 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2012 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Aug. 1, 2011 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2011 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2010 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2009 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2008 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2007 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after April 15, 2006 use:
In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Sept. 1, 2005 use:
In addition to the regulations for services provided on or after March 1, 2007, for pharmaceuticals on or after Sept. 4, 2009 see:
- Order of the administrative director of the Division of Workers' Compensation (does not make a change to reimbursable amounts) version version
Regulation effective March 1, 2007 (Section 9789.40 ) version version
Physician services
In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Feb. 15, 2007 use:
In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after May 14, 2005 use:
In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Jan. 14, 2005 use:
Order of the administrative director of the Division of Workers' Compensation rescinding two previous administrative director orders version version
For services provided on or after July 1, 2004 use:
- The 1999 edition of OMFS
- Regulations effective July 1, 2004 (Sections 9789.10 through 9789.111) version version
- Insert Pages for the OMFS effective July 12, 2002 version version)
- General Instructions (Physician Services) effective July 1, 2004 version version
- Table A 9789.11 version version
- Section 9789.40 Pharmacy: http://www.dir.ca.gov/dwc/pharmfeesched/pfs.asp
- Section 9798.50 Pathology and Laboratory http://www.cms.hhs.gov/paymentsystems
- Section 9789.60 Durable Medical Equipment, Prosthetics, Orthotics, Supplies: http://www.cms.hhs.gov/paymentsystems
- Section 9789.70 Ambulance Services: http://www.cms.hhs.gov/suppliers/ambulance/
- Payment Impact File (description) http://cms.hhs.gov/providers/hipps/impact_rcd_lay
- Payment Impact File: http://cms.hhs.gov/providers/hipps/ippspufs.asp
- CMS 2004 Hospital Outpatient Prospective Payment System: http://www.cms.hhs.gov/regulations/hopps/
- Annual Utilization Report of Specialty Clinics: http://www.oshpd.ca.gov/HID/HID/clinic/util/index.htm#Forms
- The 1999 edition of the OMFS
- Emergency regulations effective Jan. 2, 2004 version version
- Insert pages for the OMFS effective July 12, 2002 version version
- General instructions - Physician services effective Jan. 2, 2004 version version
- Table A 9789.11 Physician fees version version
- Pharmaceutical Fee Schedule: http://www.dir.ca.gov/dwc/pharmfeesched/pfs.asp
- The 1999 edition of the OMFS
- Regulations effective July 12, 2002 version version
- Insert pages for the OMFS effective July 12, 2002 version version
- OMFS Prosthetics Fee Schedule effective July 12, 2002 version
For services provided between April 1, 1999 and July 11, 2002 the 1999 edition of the OMFS should be used. Click here for the order form 
August 2012