The Division of Workers’ Compensation has posted an order adjusting the pathology and clinical laboratory section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system, as required by Labor Code section 5307.1.

Effective for services rendered on or after April 1, 2018, the maximum reasonable fees for pathology and laboratory services shall not exceed 120% of the applicable fees set forth in the April 2018 quarterly update to Medicare Clinical Laboratory Fee Schedule, contained in the electronic file “18CLABQ2” which is adopted and incorporated by reference

Outpatient clinical laboratory services are paid based on the Medicare Part B Clinical Laboratory Fee Schedule (CLFS) in accordance with Section 1833(h) of the Social Security Act.

Payment is the lesser of the amount billed, the local fee for a geographic area, or a national limit. In accordance with the statute, the national limits are set at a percent of the median of all local fee schedule amounts for each laboratory test code.

Each year, fees are updated for inflation based on the percentage change in the Consumer Price Index. However, legislation by Congress can modify the update to the fees.

The order adopting the OMFS pathology and clinical laboratory fee schedule is effective for services rendered on or after April 1, 2018 and can be found on the DWC website.