The California Division of Workers’ Compensation (CA DWC) has announced significant updates to the Physician and Non-Physician Practitioner section of the Official Medical Fee Schedule (OMFS) for workers’ compensation. Effective February 1, 2025, these changes align OMFS with Medicare payment system revisions, as required by California Labor Code Section 5307.1.
The 2025 update includes five major changes:
- Increase in Conversion Factor: The Conversion Factor rises from $48.51 to $48.79, setting OMFS reimbursements at 150.84% of Medicare rates, reflecting the higher workload involved in treating injured workers.
- Enhanced Reimbursements for California-Specific Codes: Adjustments ensure fair compensation for unique state-specific services.
- Revised Calculations for 16 Procedure Codes: Updates introduce established reimbursement rates for certain codes previously billed “By Report.”
- 318 New Procedure Codes: These additions expand the list of reimbursable services.
- 128 Deleted Procedure Codes: Outdated codes are eliminated from the OMFS.
These updates are designed to improve reimbursement accuracy and reflect the complex needs of treating workers’ compensation patients.
Cosentus is committed to helping healthcare providers navigate regulatory changes and optimize their revenue cycle management processes.
