Calculating DMEPOS Reimbursements
The DMEPOS fee schedule is a separate fee schedule from the physician and non-physician fee schedule. For workers' comp, DMEPOS is reimbursed at 120% of the currently adopted Medicare DMEPOS rate for California.
To calculate DMEPOS fee schedule, follow the steps below:
Step 1. Open the DWC's OMFS Page → Click ‘Durable medical equipment, prosthetics, orthotics and supplies’ Link
Step 2. To Download the Latest Fee Schedule Documents → Click Word or PDF Icon
Step 3. From Download → Click the ‘DME16-A’ Link
Step 4. From Medicare Website → Download ‘DME16-A’ ZIP File
Step 5. Open ZIP File → Open ‘DME2016_JAN_V1208’ File in CSV, TXT, or XLSX Format
Make sure you are using the most current fee schedule, as the DWC updates the DMEPOS fee schedule several times a year. Also, the workers' comp DMEPOS 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 DME amount listed in Medicare’s file is the reimbursement amount. You MUST make the 120% calculation yourself.
California Labor Codes
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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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