Official Medical Fee Schedule (OMFS)

The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses.

Section 9789.111 provides the effective dates of fee schedule provisions. In addition, adjustments to the fee schedule, in the form of Administrative Director Orders, are posted on the fee schedule web pages to conform to relevant Medicare and Medi-Cal changes pursuant to Labor Code section 5307.1 subdivision (g) and Title 8, California Code of Regulations, section 9789.110.

If you have questions regarding the Official Medical Fee Schedule (OMFS) email us at DWCFeeSchedule@dir.ca.gov

Topics covered in the OMFS include:
Ambulance fees
Durable medical equipment, prosthetics, orthotics and supplies
Inpatient hospital
Hospital Outpatient Departments and Ambulatory Surgical Centers Fee schedule
Pathology and clinical laboratory
Pharmaceuticals
Physician services

Ambulance fees

Effective
date
Ambulance fee schedule documents
January 1, 2020
  • Centers for Medicare and Medicaid Services Zip Code to Carrier Locality File, as revised 11/19/2019 which contains the following electronic files:
    ZPLC_JAN2020.zip
  • Centers for Medicare and Medicaid Services Zip Code requiring +4 extension, as revised 11/19/2019 which contains the following electronic file:
  • Centers for Medicare and Medicaid Services Changes to Zip Code File - as revised 11/19/2019 which contains the following electronic file:
For reference: CMS Manual System Transmittal No. 4407
January 1, 2019
  • Centers for Medicare and Medicaid Services Zip Code to Carrier Locality File, as revised 11/14/2018 which contains the following electronic files:
  • Centers for Medicare and Medicaid Services Zip Code requiring +4 extension, as revised 11/14/2018 which contains the following electronic file:
  • Centers for Medicare and Medicaid Services Changes to Zip Code File - as revised 11/14/2018 which contains the following electronic file:
For reference: CMS Manual System Transmittal No. 4172
January 1, 2018

IMPORTANT NOTE: The CY 2018 Ambulance Fee Schedule File, as revised 12/07/2017 (below), is replaced with the above file, as updated 02/14/2018. The below file is superseded with the above updated file which implements legislative provisions of the Bipartisan Budget Act of 2018.

  • Centers for Medicare and Medicaid Services Zip Code requiring +4 extension, as revised 11/15/2017 which contains the following electronic file:
  • Centers for Medicare and Medicaid Services Changes to Zip Code File - as revised 11/15/2017 which contains the following electronic file:
For reference: CMS Manual System Transmittal No. 3893
March 1, 2017
Jan. 15, 2016

Aug.1, 2015

Jan. 15, 2015
Aug. 1, 2014

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 1, 2013 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after March 1, 2012 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2011 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2009 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after July 1, 2008 use:

Centers for Medicare and Medicaid Services 2008 Public Use File, as revised Oct. 1, 2008, which contains the following electronic files:

Centers for Medicare and Medicaid Services Zip Code to Carrier Locality File, as revised Nov. 13, 2008 which contains the following electronic files:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after April 7, 2008 use:

  • Centers for Medicare and Medicaid Services 2008 Public Use File, which contains the following electronic files:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2008 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Feb. 1, 2007 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2007 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Jan. 1, 2006 use:

In addition to the regulations for services provided on or after Jan. 2, 2004, for ambulance fees on or after Sept. 8, 2005 through Dec. 31, 2005 use:

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Durable medical equipment, prosthetics, orthotics and supplies

NOTE: Workers' compensation durable medical equipment, prosthetics, orthotics, and supplies fee schedule - Physician dispensed devices
Legislation that became effective on January 1, 2012 places caps on fees for "dangerous devices" dispensed by physicians. These caps are contained in Labor Code section 5307.1.

Effective
date
Fee schedule documents
January 1, 2020
October 1, 2019
July 1, 2019
April 1, 2019
January 1, 2019
July 1, 2018
April 1, 2018
Jan. 1, 2018
Oct. 1, 2017
July 1, 2017
April 1, 2017
Feb. 1, 2017
Jan. 1, 2017
Oct. 1, 2016
July 1, 2016
April 1, 2016
Jan. 1, 2016
Oct. 1, 2015
July 1, 2015
Jan. 1, 2015
Oct. 1, 2014
April 1, 2014
January 1, 2014

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2013 use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2013 use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after January 1, 2013 use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2012 use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2012 use:

Workers' compensation durable medical equipment, prosthetics, orthotics, and supplies fee schedule - Physician dispensed devices
Legislation that became effective on January 1, 2012 places new caps on "dangerous devices" dispensed by physicians. These new caps are contained in Labor Code section 5307.1.

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2011, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2011, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2010, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2010, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2010, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2009, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2009, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 7, 2008, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2008, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2007, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 1, 2007, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 11, 2007, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 3, 2007, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 5, 2006, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Jan. 1, 2007, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 13, 2006, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Nov. 15, 2006, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Oct. 1, 2006, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after July 1, 2006, use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after April 15, 2006 use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Dec. 15, 2005 please use:

In addition to the regulations for services provided on or after Jan. 1, 2004, for durable medical equipment, prosthetics, orthotics and supplies on or after Sept. 1, 2005 use:

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Inpatient hospital

Effective
date
Inpatient hospital fee schedule documents
November 1, 2019 Orders of the Administrative Director (November 1, 2019)
December 1, 2018
December 1, 2017
January 1, 2017
March 1, 2016
March 5, 2015

IMPORTANT NOTE: The Administrative Director (AD) order (above) adjusts the inpatient hospital section of the OMFS to conform to changes in the 2015 Medicare payment system as required by Labor Code section 5307.1. The effective date of the changes is March 5, 2015. Although 2014 update factors were adopted in the OMFS rulemaking (below) with the same effective date of March 5, 2015, the 2015 update factors adopted by the AD order should be used for dates of discharge on or after March 5, 2015.

For inpatient hospital discharges on or after March 15, 2014 use:

For inpatient hospital discharges on or after March 15, 2013 use:

For inpatient hospital discharges on or after Jan. 1, 2013 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2011 use:

In addition to the regulations for services provided on or after July 1, 2004, for hospital discharges from Monrovia Memorial Hospital on or after May 1, 2009 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image
    In accordance with Monrovia Memorial Hospital's request and CMS' approval, Monrovia Memorial Hospital voluntarily terminated their CMS certification number 050762 (acute care hospital) effective April 30, 2009, and became a long term acute care hospital (LTCH) CMS certification number 052054 effective as of May 1, 2009. The Order of the administrative director removes Monrovia Memorial Hospital listed as CMS provider number 050762 from Title 8, California Code of Regulations section 9789.23 for discharges on or after May 1, 2009.

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2011 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2009 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2008 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Jan. 1, 2008 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after April 1, 2007 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after March 1, 2007 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2006 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Dec. 1, 2005 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after July 15, 2005 use:

In addition to the regulations for services provided on or after July 1, 2004, for inpatient hospital discharges on or after Nov. 29, 2004 use:

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Hospital Outpatient Departments and Ambulatory Surgical Centers Fee schedule

Effective
date
Hospital Outpatient Departments and Ambulatory Surgical Centers Fee schedule
March 1, 2020 Orders of the Administrative Director (March 1, 2020)
February 15, 2019 Orders of the Administrative Director (February 15, 2019 – October 1, 2019)
March 15, 2018 Orders of the Administrative Director (March 15, 2018 - October 1, 2018)

IMPORTANT NOTE: Section 9789.34, Table A (below), adopted for services rendered on or after March 15, 2018, inadvertently listed Los Angeles County twice with different county-specific wage indexes and wage-adjusted conversion factors. This table is superseded with a revised table (above) that deletes the incorrect duplicate entry.

June 1, 2017 Orders of the Acting Administrative Director (June 1, 2017 - October 1, 2017)
Dec. 15, 2016
Dec. 1, 2014
Sept. 1, 2014

List of facilities electing to be paid under the high cost outlier methodology: The list of facilities is for years 2004 through 2014. Each list is effective for 12 months beginning April 1 and ending March 31.

For hospital outpatient and ambulatory surgical center services rendered on or after Apr. 1, 2013 use:

For hospital outpatient departments and ambulatory surgical centers services rendered on or after Jan. 1, 2013 use:

  • Regulation effective January 1, 2013 (Sections 9789.30, 9789.31, 9789.32, 9789.33, 9789.36, 9789.37, 9789.38 and 9789.39) word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.34) Excel image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.35) Excel image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sep. 1, 2012 use:

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.30) word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.31) word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.32) word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.33) word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.34) Excel image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.35) Excel image version acrobat image version
  • Regulation effective Jul. 1, 2004 (Section 9789.36) word image version acrobat image version
  • Regulation effective Jul. 1, 2004 (Section 9789.37) word image version acrobat image version
  • Regulation effective March 1, 2012 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Sept. 15, 2011 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.30) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.31) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.32) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.33) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation (reprinted) (Section 9789.36) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.37) word image version acrobat image version
  • Regulation effective Sept. 15, 2011 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after Jul. 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Apr. 15, 2010 use:

  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.30) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.31) word image version acrobat image version
  • Regulation (reprinted) (Section 9789.32) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.33) word image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Apr. 15, 2010 (Section 9789.38) word image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2009 use:

  • Order of the acting chief deputy administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.31) word image version acrobat image version
  • Order of the acting administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.32, 9789.33, 9789.34, and 9789.35 word image version acrobat image version
  • [SUPERSEDED - DO NOT USE: Regulation effective March 1, 2009 (Section 9789.31) word image version acrobat image version ]
  • Regulation effective March 1, 2009 (Section 9789.32) word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.33) word image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2009 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.31) word image version acrobat image version
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.32) word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.33) word image version acrobat image version
  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.30) word image version acrobat image version
  • [SUPERSEDED - DO NOT USE: Regulation effective March 1, 2008 (Section 9789.31) word image version acrobat image version]
  • Regulation effective March 1, 2008 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2008 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after April 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Section 9789.35 - table B - Hospital specific wage index and wage adjusted conversion factor is adjusted to conform to CMS' notice of March 23, 2007, published in the Federal Register, Vol. 72, No. 56, FR 13799, entitled, "Medicare Program; Extension of Certain Hospital Wage Index Reclassifications" (CMS-1384-N) Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after March 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31, 9789.34, and 9789.35 word image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.31) word image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective March 1, 2007 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after Feb. 15, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.30, 9789.31 and 9789.33 - 9789.35 word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.30) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.31) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.33) word image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.34 - table A) - County specific wage index and wage adjusted conversion factor Excel image version acrobat image version
  • Regulation effective Feb. 15, 2006 (Section 9789.35 - table B) - Hospital specific wage index and wage adjusted conversion factor Excel image version acrobat image version

In addition to the regulations for services provided on or after July 1, 2004, for outpatient hospital and ambulatory surgical center services rendered on or after July 15, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version
  • Explanation of changes to Title 8, California Code of Regulations, sections 9789.31 and 9789.33 - 9789.35 word image version acrobat image version
  • Regulation effective July 15, 2005 (Section 9789.31) word image version acrobat image version
  • Regulation effective July 15, 2005 (Section 9789.33) word image version acrobat image version
  • Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - County specific wage index and wage adjusted conversion factor (section 9789.34 - table A) Excel image version acrobat image version
  • Revised adjustment to Outpatient Hospital and Ambulatory Surgical Center Fee Schedule to conform to the Nov. 15, 2004 final rule and correction notice of the Dec. 30, 2004 changes in the Medicare payment system - Hospital specific wage index and wage adjusted conversion factor (section 9789.35 - table B) Excel image version acrobat image version

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Pathology and clinical laboratory

Effective
date
Fee schedule documents
April 1, 2020
February 1, 2020
October 1, 2019
July 1, 2019
Jan. 1, 2019 Orders of the Administrative Director (January 1, 2019)
Jan. 1, 2018 Orders of the Administrative Director (January 1, 2018 – July 1, 2018)
Jan. 1, 2017
Jan. 1, 2016
Jan. 1, 2015
April 15, 2014
Jan. 1, 2014

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2013 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2012 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Aug. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2011 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2010 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2009 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2008 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Jan. 1, 2007 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after April 15, 2006 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

In addition to the regulations for services provided on or after Jan. 1, 2004, for pathology and clinical laboratory fees on or after Sept. 1, 2005 use:

  • Order of the administrative director of the Division of Workers' Compensation word image version acrobat image version

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Pharmaceuticals

In addition to the regulations for services provided on or after March 1, 2007, for pharmaceuticals on or after Sept. 4, 2009 see:

Regulation effective March 1, 2007 (Section 9789.40 ) word image version acrobat image

Fees for pharmaceuticals

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Physician services

Labor Code section 5307.1 requires the DWC administrative director to adopt an official medical fee schedule for physician services. In California, for purposes of workers' compensation "physician" is defined by Labor Code section 3209.3 subdivision (a) as follows:

"Physician" includes physicians and surgeons holding an M.D. or D.O. degree, psychologists, acupuncturists, optometrists, dentists, podiatrists, and chiropractic practitioners licensed by California state law and within the scope of their practice as defined by California state law.

The physician fee schedule also covers services of non-physician practitioners, such as physical therapists, occupational therapists, nurse practitioners, physician assistants, clinical social workers, clinical nurse specialists, nurse anesthetists, and anesthesiologist assistants.

Rules related to paper medical treatment billing and electronic medical treatment billing are posted on the DWC website.

Effective
date
Fee schedule documents
January 1, 2020 Orders of the Administrative Director (January 1, 2020 - April 1, 2020)

Regulation effective January 1, 2020, including 3/13/2020, 3/15/2020. and 4/1/2020 updates (sections 9789.12.1 through 9789.19.1)

Clean copy of regulation effective January 1, 2020, including 3/13/2020, 3/15/2020 and 4/1/2020 updates (sections 9789.12.1 through 9789.19.1)

Regulation effective January 1, 2020 (section 9789.19.1, Table A 2020 RVU20A Updated 01-22-2020) version

Medi-Cal Rates file - December 15, 2019; January 15, 2020; February 15, 2020; March 15, 2020

Medically Unlikely Edits file – January 1, 2020; April 1, 2020

January 1, 2019 Orders of the Administrative Director (January 1, 2019 – December 15, 2019)

Regulation effective January 1, 2019, including 12/15/2019 update (sections 9789.12.1 through 9789.19.1) version

Clean copy of regulation effective January 1, 2019, including 12/15/2019 update (sections 9789.12.1 through 9789.19.1) version

Regulation effective January 1, 2019 (section 9789.19.1, Table A) version

GPCI Zip Code Files – January 1, 2019; April 1, 2019; July 1, 2019; October 1, 2019

Medi-Cal Rates file - December 15, 2018; January 15, 2019; February 15, 2019; March 15, 2019;
April 15, 2019; May 15, 2019; June 15, 2019; July 15, 2019; August 15, 2019; September 15, 2019; October 15, 2019; November 15, 2019; December 15, 2019

Medically Unlikely Edits file - January 1, 2019; April 1, 2019; July 1, 2019; October 1, 2019

National Correct Coding Initiative Policy Manual - January 1, 2019 (Zip archive of pdf files)

January 1, 2018 Orders of the Administrative Director (January 1, 2018 – December 15, 2018)

Regulation effective January 1, 2018, including 12/15/2018 update (sections 9789.12.1 through 9789.19) version

Clean copy of regulation effective January 1, 2018, including 12/15/2018 update (sections 9789.12.1 through 9789.19) version

Medi-Cal Rates file - December 15, 2017; January 15, 2018; February 15, 2018; March 15, 2018; April 15, 2018; May 15, 2018; June 15, 2018; July 15, 2018; August 15, 2018; September 15, 2018; October 15, 2018; November 15, 2018; December 15, 2018

Medically Unlikely Edits file - January 1, 2018; April 1, 2018; July 1, 2018 (AD order dated July 23, 2018, replaces MUE file adopted by AD order dated June 26, 2018, with an excerpt of the same MUE file); October 1, 2018

National Correct Coding Initiative Policy Manual - January 1, 2018 (Zip archive of pdf files)

March 1, 2017 Orders of the Administrative Director (March 1, 2017 - December 15, 2017)

Regulation effective March 1, 2017, including 12/15/2017 update (sections 9789.12.1 through 9789.19) version

Clean copy of regulation effective March 1, 2017, including 12/15/2017 update (sections 9789.12.1 through 9789.19) version

Medi-Cal Rates file - February 15, 2017; March 15, 2017; April 15, 2017; May 15, 2017; June 15, 2017; July 15, 2017; August 15, 2017; September 15, 2017; October 15, 2017; November 15, 2017; December 15, 2017

Medically Unlikely Edits file - January 1, 2017 (Effective March 1, 2017); April 1, 2017; July 1, 2017; October 1, 2017

National Correct Coding Initiative Policy Manual - January 1, 2017 (Effective March 1, 2017) (Zip archive of pdf files)

January 1, 2016

Orders of the Administrative Director (January 1, 2016 – February 15, 2017)

Regulation effective January 1, 2016, including 2/15/2017 update (sections 9789.12.1 through 9789.19) version

Clean copy of regulation effective January 1, 2016, including 2/15/2017 update (sections 9789.12.1 through 9789.19) version

Medi-Cal Rates file - December 15, 2015; January 15, 2016; February 15, 2016; March 15, 2016; April 15, 2016; May 15, 2016; June 15, 2016; July 15, 2016; August 15, 2016; September 15, 2016; October 15, 2016; November 15, 2016; December 15, 2016; January 15, 2017; February 15, 2017

Medically Unlikely Edits file - Jan. 1, 2016; April 1, 2016; July 1, 2016; Oct. 1, 2016

National Correct Coding Initiative Policy Manual - Jan. 1, 2016 (Zip archive of pdf files)

March 1, 2015

Orders of the Administrative Director (March 1, 2015 – December 15, 2015)

Regulation effective March 1, 2015, including 12/15/2015 update (sections 9789.12.1 through 9789.19) version

Clean copy of regulation effective March 1, 2015, including 12/15/2015 update (sections 9789.12.1 through 9789.19) version

Medi-Cal Rates file - Feb. 15, 2015; March 15, 2015; April 15, 2015; May 15, 2015; June 15, 2015; July 15, 2015; August 15, 2015; September 15, 2015; Oct. 15, 2015; Nov. 15, 2015; Dec. 15, 2015

Medically Unlikely Edits file - Jan. 1, 2015 (Effective March 1, 2015); April 1, 2015; July 1, 2015; Oct. 1, 2015

National Correct Coding Initiative Policy Manual Jan. 1, 2015 (Effective March 1, 2015) (Zip archive of pdf files)

January 1, 2014 Orders of the Acting Administrative Director (Jan. 1, 2014 – Feb. 15, 2015)

Regulation effective January 1, 2014, including 2/15/2015 update (sections 9789.12.1 through 9789.19) version

Clean copy of regulation effective January 1, 2014, including 2/15/2015 update (sections 9789.12.1 through 9789.19) version

Medi-Cal Rates file - Jan. 1, 2014; Jan. 23, 2014; Feb 15, 2014; March 15, 2014; April 15, 2014; May 15, 2014; June 15, 2014; July 15, 2014; August 15, 2014; Sept. 15, 2014; Oct. 15, 2014; Nov. 15, 2014; Dec. 15, 2014; Jan. 15, 2015; Feb. 15, 2015

Medically Unlikely Edits file - Jan. 1, 2014; Jan. 23, 2014; April 1, 2014; July 1, 2014; Oct. 1, 2014

National Correct Coding Initiative Policy Manual Jan. 1, 2014 (Zip archive of pdf files)

For services rendered prior to Jan. 1, 2014, the physician fee schedule includes the regulations (title 8, California Code of Regulation sections 9789.10 - 9789.11), the 1999 Official Medical Fee Schedule book, update pages for the book and a table of codes and maximum rates. Amendments to Sections 9789.10 and 9789.11 were adopted by the Administrative Director and filed with the Secretary of State on February 4, 2015. The amendments reiterate the applicable dates of fee schedule provisions that are declaratory of existing laws. version version

See below for the relevant date of service.

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Feb. 15, 2007 use:

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after May 14, 2005 use:

In addition to the regulations for services provided on or after July 15, 2004, for physician services on or after Jan. 14, 2005 use:

Order of the administrative director of the Division of Workers' Compensation rescinding two previous administrative director orders word image version acrobat image version

For services provided on or after July 1, 2004 use:

  • The 1999 edition of OMFS
  • Regulations effective July 1, 2004 (Sections 9789.10 through 9789.111) word image version acrobat image version
  • Insert Pages for the OMFS effective July 12, 2002 word image version acrobat image version)
  • General Instructions (Physician Services) effective July 1, 2004 word image version acrobat image version
  • Table A 9789.11 Excel image version acrobat image version
The links referenced in the fee schedule regulations effective July 1, 2004 are:

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For services provided between Jan. 1, 2004 and June 30, 2004 use:

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For services provided between July 12, 2002 and Dec. 31, 2003 use:
  • The 1999 edition of the OMFS
  • Regulations effective July 12, 2002 word image version acrobat image version
  • Insert pages for the OMFS effective July 12, 2002 word image version acrobat image version
  • OMFS Prosthetics Fee Schedule effective July 12, 2002 acrobat image version

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For services provided between April 1, 1999 and July 11, 2002 the 1999 edition of the OMFS should be used. Click here for the order form acrobat image

For physician services and inpatient hospital facility services rendered on or before Jan. 1, 2004, see §§9790, et seq. (Amendment to Regulation 9790 was adopted by the Administrative Director and filed with the Secretary of State on February 4, 2015)

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February 2020