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

NOTE: Please do not send email such as “secure” or encrypted email, which would require registration, opening attachments, or clicking links in order to view the message. Due to security protocols, DWC staff will not be able to respond to these types of messages and they will be deleted from the email system without being read.

The DWC Fee Schedule mailbox is intended to receive questions in order to provide general information regarding the OMFS; there should be no need to send confidential information to the mailbox.

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, 2021
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
January 15, 2016

August 1, 2015

January 15, 2015

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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
Durable medical equipment, prosthetics, orthotics and supplies fee schedule documents
April 1, 2021
March 15, 2021
January 1, 2021
October 1, 2020
July 1, 2020
March 6, 2020

April 1, 2020

January 1, 2020
October 1, 2019
July 1, 2019
April 1, 2019
January 1, 2019
July 1, 2018
April 1, 2018
January 1, 2018
October 1, 2017
July 1, 2017
April 1, 2017
Feb. 1, 2017
January 1, 2017
October 1, 2016
July 1, 2016
April 1, 2016
January 1, 2016
October 1, 2015
July 1, 2015
January 1, 2015

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Inpatient hospital

Effective
date
Inpatient hospital fee schedule documents
March 15, 2021 Order of the Administrative Director (March 15, 2021)
December 1, 2020 Order of the Administrative Director (December 1, 2020)
November 1, 2019 Orders of the Administrative Director (November 1, 2019 - April 20, 2020)
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

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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, 2021 Orders of the Administrative Director (March 1, 2021 - July 1, 2021)
March 1, 2020 Orders of the Administrative Director (March 1, 2020 - October 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)
December 15, 2016

Pathology and clinical laboratory

Effective
date
Pathology and clinical laboratory Fee schedule

July 1, 2021

Orders of the Administrative Director

April 1, 2021

Orders of the Administrative Director

January 1, 2021

Orders of the Administrative Director

October 1, 2020

July 1, 2020

April 1, 2020

(and retroactive as specified in Orders)

Orders of the Administrative Director (March 1, 2020 - October 1, 2020)
February 1, 2020
October 1, 2019
July 1, 2019
January 1, 2019 Orders of the Administrative Director (January 1, 2019)
January 1, 2018 Orders of the Administrative Director (January 1, 2018 – July 1, 2018)
January 1, 2017
January 1, 2016
January 1, 2015

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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
March 1, 2021 Orders of the Administrative Director (March 1, 2021 – September 15, 2021)

Regulation effective March 1, 2021, including update order effective September 15, 2021 (sections 9789.12.1 through 9789.19.1)

Clean copy of regulation effective March 1, 2021, including update order effective September 15, 2021 (sections 9789.12.1 through 9789.19.1)

Regulation effective March 1, 2021 (section 9789.19 Table A)

Medi-Cal Rates file -February 16, 2021; March 15, 2021; April 15, 2021; May 15, 2021; June 15, 2021; July 15, 2021; August 15, 2021; September 15, 2021

Medically Unlikely Edits file – January 1, 2021 (Effective March 1, 2021); April 1, 2021; July 1, 2021
January 1, 2020 Orders of the Administrative Director (January 1, 2020 - February 16, 2021)

Regulation effective January 1, 2020, including 2/16/2021 update (sections 9789.12.1 through 9789.19.1)

Clean copy of regulation effective January 1, 2020, including 2/16/2021 update (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)

Medi-Cal Rates file - December 15, 2019; January 15, 2020; February 15, 2020; March 15, 2020; April 15, 2020; May 15, 2020; June 15, 2020; July 15, 2020; August 15, 2020; September 15, 2020; October 15, 2020; November 15, 2020; December 15, 2020; January 15, 2021; February 16, 2021

Medically Unlikely Edits file – January 1, 2020; April 1, 2020; July 1, 2020; October 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)

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

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

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 - Access on the CMS NCCI Policy Manual webpage

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)

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

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 - Access on the CMS NCCI Policy Manual webpage

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)

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

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 - Access on the CMS NCCI Policy Manual webpage

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)

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

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 - January 1, 2016; April 1, 2016; July 1, 2016; October 1, 2016

National Correct Coding Initiative Policy Manual - Access on the CMS NCCI Policy Manual webpage

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)

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

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; October 15, 2015; Nov. 15, 2015; December 15, 2015

Medically Unlikely Edits file - January 1, 2015 (Effective March 1, 2015); April 1, 2015; July 1, 2015; October 1, 2015

National Correct Coding Initiative Policy Manual - Access on the CMS NCCI Policy Manual webpage

January 1, 2014 Orders of the Acting Administrative Director (January 1, 2014 – February 15, 2015)

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

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

Medi-Cal Rates file - January 1, 2014; January 23, 2014; Feb 15, 2014; March 15, 2014; April 15, 2014; May 15, 2014; June 15, 2014; July 15, 2014; August 15, 2014; September 15, 2014; October 15, 2014; Nov. 15, 2014; December 15, 2014; January 15, 2015; Feb. 15, 2015

Medically Unlikely Edits file - January 1, 2014; January 23, 2014; April 1, 2014; July 1, 2014; October 1, 2014

National Correct Coding Initiative Policy Manual - Access on the CMS NCCI Policy Manual webpage

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July 2021