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NEWSLINE
Release Number: 2020-49
May 28, 2020

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

On March 30, 2020, the Administrative Director of the Division of Workers’ Compensation (DWC) issued an order that title 8, California Code of Regulations, section 9789.39, pertaining to the Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule portion of the Official Medical Fee Schedule, be adjusted to conform to changes in the Medicare system, effective for services rendered on or after April 1, 2020. Subsequently, on May 4, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a corrected Addendum B to supersede the previous document, effective April 1, 2020.

The order is the second Administrative Director order for services rendered on or after April 1, 2020 to the Hospital Outpatient Departments/Ambulatory Surgical Centers Fee Schedule.

The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:

  • Adopt and incorporate by reference CMS’ HOPPS addendum B found in the April 2020 CORRECTION (ZIP) – updated 5/4/2020 file, in place of the original file, for services rendered on or after April 1, 2020, except that HCPCS Code C9803 is effective for services on or after March 1, 2020.
  • Certain sections of the CMS Medicare OPPS April 2020 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V21.1 R2 Apr 2020 quarterly update.
  • On April 30, 2020, CMS issued the Interim Final Rule with Comment Period [CMS-5531-IFC] “Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program.” The Interim Final Rule with Comment Period [CMS-5531-IFC] adopts a wide variety of temporary emergency provisions to address the COVID-19 pandemic in order to increase access to needed care and appropriately reimburse medical providers. In the Interim Final Rule, CMS adopts a new COVID-19 specimen collection code, C9803, effective March 1, 2020, to be used by hospital outpatient departments during the public health emergency.

The Administrative Director update order dated March 30, 2020 remains in effect for services rendered on or after April 1, 2020, except as modified by Administrative Director order dated May 15, 2020. The Orders and regulations can be found at the DWC website’s OMFS page.