April 4, 2025 | Oakland, CA — MedLegalNews.com –DWC Medical Fee Schedule Update: The California Division of Workers’ Compensation (DWC) has announced new updates to the Official Medical Fee Schedule (OMFS), specifically for Physician Services and Non-Physician Practitioner Services. These adjustments, which take effect for services rendered on or after April 1, 2025, ensure California’s workers’ compensation billing aligns with the latest changes in the federal Medicare payment system.
The DWC medical fee schedule update reflects California’s ongoing effort to maintain consistency with national reimbursement frameworks while supporting fair compensation for medical providers. By mirroring Medicare’s quarterly revisions, the DWC ensures that state workers’ compensation payments remain up to date with evolving federal standards, minimizing discrepancies in billing and payment calculations. This update is particularly important for physicians, nurse practitioners, and physician assistants, as it directly impacts how procedures, evaluation codes, and relative value units (RVUs) are applied.
According to the Division, these revisions are designed not only to streamline billing and coding accuracy but also to enhance transparency across claims processing and audit functions. Providers are urged to review the updated OMFS order and confirm that their billing systems and software are recalibrated to comply with the new Medicare-based payment parameters effective April 1, 2025.
Key Changes Included in the Update
As mandated by Labor Code section 5307.1, the OMFS must conform to Medicare’s quarterly revisions. Consequently, the new order incorporates several important updates, including:
- The Medicare National Physician Fee Schedule Relative Value File (RVU24B), effective April 1, 2025.
- Updates to ZIP Code-to-Carrier Locality Mapping Files, which help determine reimbursement based on location.
- Revised Practitioner Procedure-to-Procedure (PTP) Edits, which flag coding conflicts.
- Modified Medically Unlikely Edits (MUEs) that limit reimbursement for services unlikely to occur together.
The DWC medical fee schedule update also underscores the state’s continued commitment to improving data accuracy and administrative efficiency within the workers’ compensation system. By adopting Medicare’s latest coding and billing standards, the DWC aims to minimize claim disputes and reduce the administrative burden on both payers and providers.
These updates help align California’s reimbursement methodology with national norms, ensuring consistency in how services are valued and preventing regional disparities in payment amounts.
Where to Access the Updated Fee Schedule
Providers and stakeholders can view the updated order on the DWC Physician Services and Non-Physician Practitioner Services webpage. It’s essential for billing departments, medical providers, and claims professionals to review these changes promptly to ensure compliance.
Access the official California Division of Workers’ Compensation (DWC) page to review the updated medical fee schedule and reference materials.
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FAQs: DWC Medical Fee Schedule Update
What is the DWC medical fee schedule update?
The DWC medical fee schedule update reflects California’s quarterly alignment with Medicare reimbursement changes, ensuring compliance and accurate provider payments.
When does the latest DWC medical fee schedule update take effect?
The most recent DWC medical fee schedule update applies to services rendered on or after April 1, 2025, in accordance with Labor Code section 5307.1.
How does the DWC medical fee schedule update affect providers?
Providers must review the new RVU values, locality mapping files, and revised coding edits to maintain proper billing and avoid reimbursement denials.
Where can providers access the official DWC medical fee schedule update?
Providers can find the full DWC medical fee schedule update on the official DWC website under Physician and Non-Physician Practitioner Services.