Frequently Asked Questions
Accessing the DWC Pharmaceutical Fee Schedule
To find the Pharmaceuticals Fee Schedule, navigate to the Department of Industrial Relations Official Medical Fee Schedule (OMFS) website which hosts the pharmaceutical fee schedule calculator.
The DWC Pharmacy Fee Schedule and Past Dates of Service
DaisyBill’s Work Comp Wizard stores historical reimbursement data whenever possible.
Regulations for CPT Code 99070 for Physician-Dispensed Drugs
The California workers’ comp regulations validating CPT Code 99070 for billing physician-dispensed drugs are difficult to find and difficult to understand. We created a breakdown of these regulations, including where to find the regulations and how to correctly interpret them.
§ 9789.40 Pharmacy
The Department of Workers’ Compensation maintains the Official Medical Fee Schedule (OMFS), which consists of seven separate parts. Each of the seven parts of the OMFS have a fee schedule and associated billing requirements.
How do I bill dispensed pharmaceuticals?
Reimbursement for dispensed pharmaceuticals is governed by the Pharmaceutical Fee Schedule as set forth in Section 9789.40 of the Labor Code.
Do I have to include the name of the drug for physician-administered drugs?
ANSWER: Yes, 9789.13.2 (d) states that all claims for a physician-administered drug, biological, vaccine or blood product must include the specific name of the drug and the dosage.
Dispensed Pharmaceutical Not in the Medi-Cal Rates File
For workers' comp, some physician-administered pharmaceutical reimbursements are not listed in the Medi-Cal Rates file, and can instead be found in the Medi-Cal Pharmacy Fee Schedule (also known as the DWC Pharmaceutical Fee Schedule). Remember that the Medi-Cal Rates file and the Medi-Cal Pharmacy Fee Schedule are two different fee schedules. Confusing, we know!
Converting 10-digit NDC Numbers to 11 Digits
Many NDCs are displayed on drug packaging in the 10 digit format. However, when entering an NDC number on a bill, the NDC must be 11 digits. No sweat – it’s just a matter of adding a well-placed zero. Our guide below shows you how to convert 10-digit National Drug Code (NDC) numbers to 11 digits.
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