DWC Posts Additional Adjustment to Official Medical Fee Schedule (Pathology and Clinical Laboratory)

The Administrative Director of the Division of Workers’ Compensation (DWC) issued an order on January 5, 2023, adjusting the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) to conform to the 2023 Quarter One changes in the Medicare payment system as required by Labor Code section 5307.1. Subsequently, on January 12, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a revised Clinical Laboratory Fee Schedule file.

DWC has posted a supplemental order to adopt the January 12, 2023, Medicare Clinical Laboratory File in place of the original file for services on or after January 1, 2023. The new file revises two codes for SARS-COVID-19 testing (CPT 87426 and CPT 87811), adopting the national price for those codes when billed with the “QW” modifier. For those two codes, the new file sets the price at the same national price previously established for those two codes without the modifier.

The Administrative Director update order dated January 5, 2023, remains in effect for services rendered on or after January 1, 2023, except as modified by Administrative Director order dated February 2, 2023, adopting the Clinical Laboratory file updated January 12, 2023 effective for services on or after January 1, 2023.

The order can be found on the website of the Division of Workers’ Compensation on the Pathology and Clinical Laboratory webpage.

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