DWC Posts Additional Adjustment to Official Medical Fee Schedule for Pathology and Clinical Laboratory
The Division of Workers’ Compensation (DWC) issued an order dated December 27, 2024, adjusting the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule (OMFS) to conform to the 2025 Quarter One changes in the Medicare payment system as required by Labor Code section 5307.1. Subsequently, the Centers for Medicare and Medicaid Services (CMS) issued a revised Clinical Laboratory Fee Schedule file.
DWC has posted an order adopting the Medicare calendar year 2025 Q1 Pathology and Clinical Laboratory Fee Schedule file modified 1/8/2025 in place of the original file for services on or after January 1, 2025. The new file revises the nationally priced fee for code CPT 0340U from 02919.60 to 03920.00. The new file also adds codes CPT 0521U – CPT 0530U but no nationally priced fee for these codes were provided because CMS lists them as locally priced.
The Administrative Director order dated December 27, 2024, remains in effect for services rendered on or after January 1, 2025, except as modified by the Administrative Director order dated February 6, 2025, which adopts the CMS Clinical Laboratory file updated January 8, 2025, in place of the original file.
The order can be found on the Division of Workers’ Compensation website on the Pathology and Clinical Laboratory webpage.