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 October 4, 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 October 18, 2022. 

DWC has posted an order to adopt specified columns of certain tables of the CMS October 2022 ASC Approved HCPCS Code and Payment Rates file updated on October 18, 2022, which replaces the file dated September 29, 2022 , to define “surgical codes” for services rendered on or after October 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-updated 10/18/2022, and Addendum B-updated 10/18/2022, in place of the original files for services rendered on or after October 1, 2022.

The Administrative Director update order dated October 4, 2022 remains in effect for services rendered on or after October 1, 2022, except as modified by Administrative Director order dated October 21, 2022.

The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2022 and is posted on the DWC website.

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