April 2025 Adjustments Align with Medicare Quarterly Changes
April 04, 2025 – MedLegalNews – DWC Updates Medical Fee: 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.
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.
These updates aim to ensure fair and accurate reimbursement, enhance coding compliance, and streamline claims processing within California’s workers’ compensation system.
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.
Read More on MedLegalNews.com
- California Lawmakers Demand Answers Over $3.44 Billion Medi-Cal Loan
- CA Insurance Commissioner Reappoints Two to WCIRB Governing Committee
- Construction Company Cited $157,500 After Fatal Trench Collapse
- California Attorney General Bonta Reaches $1.3 Million Settlement in Fake Health Insurance Case
For ongoing updates on workers’ compensation billing and policy, visit MedLegalNews.com.