DWC Posts Additional Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

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

The order is the second Administrative Director order for services rendered on or after July 1, 2019 to the Hospital Outpatient Departments/Ambulatory Surgical Centers Fee Schedule. The order adopts the following changes:

• Adopts the Centers for Medicare and Medicaid Services (CMS) June 27, 2019 corrected addenda AA and EE of the “July 2019 ASC Approved HCPCS Code and Payment Rates” file, which provides a partial list of surgical codes payable under the hospital outpatient fee schedule. (This is a technical revision; the updated file makes no changes to the list of surgical codes.)
• Adopts a correction to payment rules for Comprehensive APCs (codes assigned status indicator “J1” or “J2”) by deleting reference to section 5.4.2, of the IOCE Quarterly Data Files V20.2.

The Administrative Director update order dated June 26, 2019 remains in effect for services rendered on or after July 1, 2019, except as modified by Administrative Director order dated July 2, 2019.

The orders and regulations can be found at the DWC website’s OMFS page.

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