February 07, 2025 | Oakland, CA — MedLegalNews.com — The Division of Workers’ Compensation (DWC) has announced additional modifications to the Official Medical Fee Schedule (OMFS) for the pathology and clinical laboratory fee schedule 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.
The revision ensures that California’s workers’ compensation reimbursement framework remains consistent with current federal benchmarks and accurately reflects evolving clinical testing costs. These updates aim to enhance payment transparency, minimize billing discrepancies, and maintain alignment between state and federal medical billing standards across pathology and laboratory services.
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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FAQS: Pathology and Clinical Laboratory Fee Schedule
What changes were made to the pathology and clinical laboratory fee schedule for 2025?
The DWC updated its pathology and clinical laboratory fee schedule to reflect Medicare’s Q1 2025 revisions, including new CPT codes and adjusted pricing for certain lab tests.
Why did DWC revise the pathology and clinical laboratory fee schedule?
DWC revised the pathology and clinical laboratory fee schedule after CMS released a corrected Clinical Laboratory Fee Schedule on January 8, 2025, to ensure payment accuracy.
How do these fee schedule updates affect reimbursement rates?
The updated pathology and clinical laboratory fee schedule impacts reimbursement levels for specific procedures, including an increase in the national rate for CPT Code 0340U.
Where can providers access the latest pathology and clinical laboratory fee schedule?
Providers can view the current pathology and clinical laboratory fee schedule directly on the DWC website, which includes detailed tables and downloadable updates.