The Administrative Director of the Division of Workers’ Compensation has ordered that the pathology and clinical laboratory portion of the Official Medical Fee Schedule adopted in title 8, California Code of Regulations, section 9789.50, is adjusted to conform to changes to the Medicare payment system that were adopted by the Centers for Medicare & Medicaid Services (CMS) for services rendered on or after April 1, 2020.
The update includes fee schedule changes identified in CMS Transmittal 4541, Change Request CR11681, which may be accessed on the Medicare website.
The CMS has adopted two new Health Care Common Procedure Coding System (HCPCS) Level II codes, U0001 and U0002, for use in diagnosing the novel corona virus, Covid-19. The HCPCS Level two codes U0001 and U0002 are adopted for services rendered in the workers’ compensation system.
HCPCS Codes U0001 and U0002 are listed in the CMS 20CLABQ2 file, but fees are not set forth as National payment amounts are not yet set. In the meantime, Medicare uses the fees determined by the local Medicare Administrative Contractor as the Medicare rate. These fees are based upon the CMS’ Medicare Administrative Contractor’s local rate for California as published by CMS in the document entitled “Medicare Administrative Contractor (MAC) COVID-19 Test Pricing March 12, 2020”.
For workers’ compensation, the maximum reasonable fee is 120% of the Medicare rate pursuant to Labor Code section 5307.1.
Short Descriptor: 2019-nCoV diagnostic P
Long Descriptor: CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
Medicare Fee: $35.91
Maximum workers’ compensation fee: $43.09
Short Descriptor: COVID-19 lab test non-CDC
Long Descriptor: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
Medicare Fee: $51.31
Maximum workers’ compensation fee: $ 61.57