San Francisco, CA – The Division of Workers’ Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2015 changes in the Medicare payment system as required by Labor Code section 5307.1.
The Physician and Non-Physician Practitioner Fee Schedule based on the federal Resource Based Relative Value Scale (RBRVS) was adopted pursuant to the requirements of Senate Bill 863 (SB 863) and became effective for services rendered on or after January 1, 2014. As mandated by SB 863, the fee schedule starts with separate conversion factors for surgery, radiology, and “all other services” in 2014 and transitions to a single conversion factor (CF) beginning in 2017, for all services except anesthesia. The 2015 transition conversion factors reflect a blend of 50 percent pre-2014 OMFS CF and 50 percent 120% RBRVS Medicare CF.
The Physician and Non-Physician Practitioner Fee Schedule update order adopts revisions to several sections of Title 8 California Code of Regulations, including the following changes:
- Adopts the CMS Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU15A and related files for services rendered on or after March 1, 2015
- Updates the Conversion Factors, applying the Medicare relative value scale adjustments and the Medicare Economic Index (MEI) inflation increase to the transitional conversion factors set forth in the regulation
- Updates the Statewide Geographic Adjustment Factors
- Adopts the 2015 National Correct Coding Initiative Edits/2015 NCCI Policy Manual
- Updates the California specific codes with the MEI inflation increase
The administrative director update order adopting the OMFS adjustments effective for services rendered on or after March 1, 2015, can be found on the DWC website. An explanation of changes is attached to the order, identifying the basis for the changes included in the update.
Source: CA DWC