2017 Physician and Non-Physician Fee Schedule

The California Division of Workers’ Compensation (DWC) posted an order announcing their upcoming adjustment to the Physician and Non-Physician section of the Official Medical Fee Schedule (OMFS). The move was widely expected, as it allows the DWC to conform to the Medicare payment system, as required by Section 5307.1 of the California Labor Code.

Frequently Asked Question

Q: When does the 2017 Physician and Non-Physician Fee Schedule go into effect?

A: The new fee schedule is effective for all dates of service on or after March 1, 2017. Until that time, the 2016 Physician and Non-Physician Fee Schedule remains in effect.

Explanation

The DWC order includes the following new values used to calculate reimbursements for procedure codes for services provided by Physicians and Non-Physicians on or after March 1, 2017:

  1. New Conversion Factors listed in CCR § 9789.19(d) 
  2. Updated CMS Medicare National Physician Fee Schedule Relative Value Units File (File Name: RVU17A).

Effective March 1st, these two new values combine to alter all reimbursement amounts.

New Conversion Factors

You’re likely familiar with the conversion factors (CFs) used to calculate reimbursements for different kinds of procedures. In the past, there have been four separate CFs to keep track of – one for anesthesia, one for surgery, one for radiology, and one for all other services.

Senate Bill 863 requires that this system is simplified in 2017. Effective March 1, the conversion factors for surgery and radiology will roll into the CF for all other services, leaving a total of just two conversion factors – one for anesthesia, and one for all other services. For more information, visit our blog.

Updated RVU File                                

To manually calculate payment amounts for the 2017 Physician and Non-Physician Fee Schedule, you must use one of two formulas:

                                        

2017 Non-Facility Pricing Amount =

[(Work RVU * Work GPCI) + (Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]

* Conversion Factor (CF)

                                        

2017 Facility Pricing Amount =

[(Work RVU * Work GPCI) + (Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)]

* Conversion Factor

                        

Each formula requires three Relative Value Units. For dates of service on or after March 1, 2017, the DWC uses Medicare’s new RVUs. You may download the 2017 Quarter 1 RVUs, or RVU17A, from the Medicare website by clicking this link.

Additional Information

DIR Newsline 2017-06

DWC Official Medical Fee Schedule

California Labor Code Section 5307.1

Medicare RVU17A

DaisyBill Resources

Blog Post: DWC Adopts Changes to Physician Fee Schedule, Effective March 1

Webinar: 2017 Work Comp Changes

DaisyBill Solution

For the easiest way to keep up with California fee schedules and rule changes, sign up for the DaisyBill Work Comp Wizard. Click below for a FREE three day trial and start easy calculations today.

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