Summary
In California, 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
Step 2. Next to ‘Order of the Administrative Director’ → Click Word or PDF Icon
Step 3. From Download → Click ‘16CLAB’ Link
This link navigates you directly to the Medicare website to download the 2016 Clinical Laboratory Fee Schedule.
Step 4. Read License Agreement → Click ‘Accept’
Step 5. Open ‘CLAB2016’ File in Desired Format
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
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
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