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Release Number: 2022-45
Date: June 7, 2022

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

The Administrative Director of the Division of Workers’ Compensation (DWC) issued an order on April 5, 2022 adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to the quarterly changes in the Medicare payment system as required by Labor Code section 5307.1. Subsequently, the Centers for Medicare and Medicaid Services (CMS) issued revised fee schedule documents dated April 6, 2022. 

DWC has posted an order to adopt specified columns of certain tables of the CMS April 2022 ASC Approved HCPCS Code and Payment Rates file updated on April 6, 2022, which replaces the file dated March 28, 2022, to define “surgical codes,” for services rendered on or after April 1, 2022. The revision makes no changes to the HCPCS codes listed in column A of addendum AA and column A of addendum EE.  

The order also adopts and incorporates by reference CMS’ HOPPS Addendum A-CORRECTION and Addendum B-updated 4/6/2022, in place of the original files, for services rendered on or after April 1, 2022. The revised addenda have value changes for APC 9204 and HCPCS J9273. No other changes are made by the revision.

The Administrative Director update order dated April 5, 2022 remains in effect for services rendered on or after April 1, 2022, except as modified by Administrative Director order dated May 12, 2022. The orders and regulations can be found at the DWC website’s OMFS page.