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§ 9789.50 Pathology and Laboratory

Summary

The Pathology and Laboratory fee schedule is a separate fee schedule from the Physician and Non-physician fee schedule. For workers' comp, pathology and laboratory services are reimbursed at 120% of the currently adopted Medicare CMS Clinical Diagnostic Laboratory Fee Schedule.

To download the Pathology and Laboratory fee schedule, follow the steps below:

Step 1. Open the DWC's OMFS Page → Click ‘Pathology and clinical laboratory’ Link

DWC OMFS - Official Medical Fee Schedule

Step 2. Next to ‘Order of the Administrative Director’ → Click Word or PDF Icon

Pathology and clinical laboratory

Step 3. From Download → Click ‘16CLAB’ Link

This link navigates you directly to the Medicare website to download the 2016 Clinical Laboratory Fee Schedule.

Pathology and Clinical Laboratory Fee Schedule

Step 4. Read License Agreement → Click ‘Accept’

Pathology and Clinical Laboratory Agreement

Step 5. Open ‘CLAB2016’ File in Desired Format

2016 Pathology and Clinical Laboratory Fee Schedule File

Make sure you are using the most current fee schedule, as the DWC updates the Pathology and Laboratory fee schedule several times a year. Also, the workers' comp Pathology and Laboratory fee schedule may not be updated on the same schedule as the Medicare one, so don't rely on only Medicare sources.

IMPORTANT: Don’t make the mistake of thinking the amount listed in Medicare’s file is the reimbursement amount. You MUST make the 120% calculation yourself.

California Labor Codes

§ 5307.1

Centers for Medicare and Medicaid Services Websites

Clinical Laboratory Fee Schedule

California Code of Regulations (CCR)

§ 9789.50 Pathology and Laboratory

Division of Workers’ Compensation Websites

DWC Official Medical Fee Schedule

DaisyBill Solution

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