San Francisco, CA – The Division of Workers’ Compensation (DWC) has received questions from the public regarding the July 1 update to the Physician Fee Schedule and its impact on acupuncture treatment.
It is important for the public to know that acupuncture continues to fall within the definition of “medical treatment” as defined in Labor Code section 4600 and is available to the injured worker when it is medically necessary to cure or relieve the effects of the injury.
The July 1 update to the Physician and Non-Physician Practitioner Fee Schedule includes updates to the National Correct Coding Initiative “Medically Unlikely Edits” (MUE). The MUE edits file sets forth the number of units of service related to a specific procedure that are medically likely to be reported by a treating physician, and serves as a useful screening tool to identify possible billing errors for many procedure codes.
However, in the July MUE file which was adopted by DWC, the acupuncture codes were included for the first time, and were listed with a value of zero. The Division is reviewing the July MUE file to determine what action is necessary to alleviate confusion caused by the July update.
DWC expects to issue a modified July 2018 Physician Fee Schedule update shortly to address this issue.
In the meantime, the public is advised that acupuncture treatment continues to be available to the injured workers when medically necessary. Maximum reimbursement for acupuncture continues to be subject to the Physician Fee Schedule without application of the MUE edit.
Source: CA DWC