DWC Posts 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 and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.

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

July 2020 Quarterly Update

• The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) July 2020 Addendum A quarterly update
• The CMS Medicare OPPS July 2020 Addendum B quarterly update
• The CMS Ambulatory Surgical Center Payment System, July 2020 ASC Approved HCPCS Code and Payment Rates – Updated 06/29/2020, Column A entitled “HCPCS Code” of “CY 2020 Jul ASC AA” and Column A entitled “HCPCS Code” of “CY 2020 Jul ASC EE”
• Certain sections of the CMS Medicare OPPS July 2020 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V21.2 quarterly update

Revision to April 2020 Quarterly Update:

• April 2020 ASC Approved HCPCS Code and Payment Rates located in April 2020 ASC Approved HCPCS Code and Payment Rates (cy2020_april_asc_addenda_03262020) is replaced by April 2020 ASC Approved HCPCS Code and Payment Rates – Updated 04/09/2020 (cy2020_april_asc_addenda.04092020.xlsx)

The replacement April 2020 ASC Approved HCSPCS Code and Payment Rates file is retroactive to April 1, 2020.

The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2020 and is posted on the DWC website.

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