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Release Number: 2020-41
May 12, 2020

DWC Posts Additional Adjustments to Official Medical Fee Schedule Including Expansion of Telehealth to Address COVID-19 Emergency (Physician and Non-Physician Practitioner Services)

The Division of Workers’ Compensation (DWC) has posted an order dated May 7, 2020, adjusting the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to additional Medicare fee schedule changes pursuant to Labor Code section 5307.1. The order includes technical updates and provisions to support expanded access to telehealth services.

The Centers for Medicare and Medicaid Services (CMS) has issued an Interim Final Rule to adopt additional temporary modifications to the Medicare Physician Fee Schedule to improve access to medical care through telehealth during the public health emergency. The Interim Final Rule adopts an expanded list of medical services (“Covered Telehealth Services for PHE for the COVID-19 pandemic effective March 1 2020-updated April 30 2020”) that may be billed for telehealth using video and audio technology, and includes identification of services that could be provided through audio-only where medically appropriate. DWC has retroactively adopted the revised telehealth list for services rendered on or after March 1, 2020, and has also adopted a retroactive revision to the Place of Service Code, which may result in an increase in fees for telehealth services if the physician provides the service in a “non-facility” setting.

The CMS Interim Final Rule temporarily increases fees for three telephone evaluation and management codes (CPT codes 99441, 99442, 99443) retroactive to March 1, 2020 to provide parity between these codes and evaluation and management codes for services rendered in person or by audio/video telehealth. DWC has adopted the retroactive increases for these three codes, which will support the provision of medical care for injured workers and further the goal of maintaining social distancing.

The Administrative Director order also adopts the CMS revised 2020 Relative Value Unit file, “RVU20B (Updated 05/01/2020),” which replaces the initial quarter two RVU20B file. The revised file is substantially identical to the original file. The significant change for workers’ compensation services is the increase of the relative values for CPT codes 99441 through 99443 discussed above.

Workers’ compensation claims administrators should adjust payment systems in light of the retroactive changes, and set up a process to reevaluate claims for services rendered on or after March 1, 2020 that may have additional payment due so that the balance owing is remitted to the provider. If a provider believes that the revised fee schedule would result in an increased payment for services rendered, they may submit a corrected bill or request for second review as appropriate.

The order adopting the updated Physician and Non-Physician Practitioner fee schedule can be found on the DWC fee schedule web page.