The DWC Pharmacy Fee Schedule and Past Dates of Service

DaisyBill’s OMFS Calculator stores historical reimbursement data whenever possible.

Frequently Asked Question

Q: Does the DWC Pharmacy Fee Schedule work for past dates of service?

A: Not always. Even though California’s Workers’ compensation pharmacy fee schedule - Simple prescription (Pharmacy Fee Schedule) requires a date of service to calculate the reimbursement for an NDC number, the Pharmacy Fee Schedule only returns the correct reimbursements for new and existing NDC numbers. The DWC Pharmacy Fee Schedule does not store reimbursement information for deleted NDC numbers.

Every Wednesday the DWC updates the reimbursement amounts listed in the DWC Pharmacy Fee Schedule. Each Wednesday the changes to the Pharmacy Fee Schedule include the following:

  1. New NDC numbers with reimbursements
  2. Existing NDC numbers with new reimbursement amounts
  3. Deletion of existing NDC numbers and reimbursements

For NDC numbers deleted by a weekly update, the Pharmacy Fee Schedule incorrectly states “No record matches the NDC number with a price date on or before xx/xx/xxxx.”  However, those deleted NDC numbers remain valid and reimbursable for their prior effective dates of service. Below see an example of a deleted NDC number with this incorrect message.

Example of Deleted NDC Number Incorrect Message

  • On 8/6/2014 the Pharmacy Fee Schedule deleted NDC number 76420052401.
  • Entering NDC number 76420052401 into the DWC Pharmacy Fee Schedule with a date of service of 7/10/2014 results in an incorrect message stating: “No record matches the NDC number with a price date on or before 07/10/2014.”

DaisyBill OMFS Calculator

DaisyBill OMFS Calculator

The DaisyBill OMFS Calculator stores legacy reimbursement data for all NDC numbers going back to March 2007.

For the same NDC number 76420052401 and same date of service 7/10/2014, DaisyBill’s OMFS Calculator correctly returns the following reimbursement information:

  • Base Maximum Fee: $342.79 for a single unit.
  • Effective Date: 01/01/2014
  • Ground Rules: Dispensing fee of $7.25 due per § 9789.40 (b)

DaisyBill OMFS Calculator

For the same NDC number 76420052401 with a date of service that falls after the DWC weekly update that deleted the NDC number from the Pharmacy Fee Schedule, the DaisyBill OMFS Calculator returns a message indicating an invalid NDC number along with the date the NDC number expired.

DaisyBill OMFS Calculator

DaisyBill Solution

For easier fee schedule calculations, sign up for a free trial of the DaisyBill OMFS Calculator.

Try the DaisyBill OMFS Calculator

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