February 7, 2025 – Pathology and Clinical Laboratory Fee: Updated Medicare Payment Changes Impact 2025 Reimbursements
The Division of Workers’ Compensation (DWC) has announced additional modifications to the Official Medical Fee Schedule (OMFS) for Pathology and Clinical Laboratory services. These adjustments align with Medicare’s Quarter One (Q1) 2025 updates, as mandated by Labor Code Section 5307.1.
Initially, DWC issued an order on December 27, 2024, to incorporate Medicare’s Q1 payment changes. However, after the Centers for Medicare and Medicaid Services (CMS) released a revised Clinical Laboratory Fee Schedule on January 8, 2025, DWC updated its order to reflect the latest changes.
Key Fee Schedule Updates for 2025
Effective January 1, 2025, the revised fee schedule includes:
- Updated Pricing for CPT Code 0340U – The nationally priced fee has increased from $29,219.60 to $39,200.00.
- Newly Added CPT Codes (0521U – 0530U) – While CMS has introduced these codes, they remain locally priced rather than nationally standardized.
The Administrative Director’s order from December 27, 2024, remains in effect, except where modified by the February 6, 2025, order, which fully adopts CMS’s updated Clinical Laboratory file issued on January 8, 2025.
Where to Find the Latest Fee Schedule Updates
For more details, visit the DWC’s Pathology and Clinical Laboratory Fee Schedule webpage here.
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