Workers' compensation pharmaceutical fee schedule - Update Information

NOTICE: The pharmaceutical fee schedule is revised for dates of service on or after July 1, 2025. Updated Pharmaceutical Fee Data Files and National Provider Identifier Files will be posted on a weekly basis beginning shortly before the July 1, 2025, effective date. The new fee schedule implements a revised pricing methodology based upon Medi-Cal changes and implements provisions of Labor Code section 5307.1 related to physician dispensing of pharmaceuticals.  You may review details of the revisions on the DWC Approved Regulations webpage. To assist the public, sample data files are being provided to allow programming of business systems used for pharmaceutical billing or bill review and payment. A new Pharmaceutical Fee Calculator will be provided as a service for the public. It is anticipated that further sample files will be issued, and the calculator will be made available for a public beta testing period in the first quarter of 2025. Further information will be provided in the coming weeks. Notices relating to the Pharmaceutical Fee Schedule will be sent to the DWC Newsline mailing list. You may subscribe to the DWC Newsline mailing list on the DIR subscription web page.

Please send comments or questions to DWCFeeSchedule@dir.ca.gov.

Sample Pharmaceutical Fee Schedule and National Provider Identifier data files for new fee schedule

The data files are presented for use by the public in programming billing and payment systems; they are NOT currently effective for payment. For modeling and system development purposes only these files assume an implementation date of January 1, 2023.

Resources

December 2024