The Division of Workers’ Compensation has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
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.
Senate Bill 863, passed on Aug. 31, 2012 and signed into law by Governor Brown on Sept. 18, 2012, required the Administrative Director of the Division of Workers’ Compensation to adopt a new physician fee schedule based on the resource-based relative value scale (RBRVS) used in the Medicare Physician Fee Schedule. It is effective for services rendered on or after January 1, 2014.
RBRVS assigns procedures performed by a physician or other medical provider a relative value which is adjusted by geographic region (so a procedure performed in Manhattan is worth more than a procedure performed in Dallas). This value is then multiplied by a fixed conversion factor, which changes annually, to determine the amount of payment. RBRVS determines prices based on three separate factors: physician work (54%), practice expense (41%), and malpractice expense (5%).[
The Physician and Non-Physician Practitioner Fee Schedule update Order adopts the following Medicare changes:
– Centers for Medicare and Medicaid Services (CMS) Medicare National Physician Fee Schedule Relative Value File RVU17C July 1, 2017 quarterly update
– National Correct Coding Initiative Physician/Practitioner Services CCI Edits July 1, 2017 quarterly update
– National Correct Coding Initiative Medically Unlikely Edits July 1, 2017 quarterly update
The order adopting the OMFS adjustments is effective for services rendered on or after July 1, 2017 and is posted on the DWC website.