DWC Posts Additional Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

The Division of Workers’ Compensation (DWC) posted an order dated January 11, 2024, adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. Subsequently, the Centers for Medicare & Medicaid Services (CMS) issued revised documents for the 2024 Quarter One update.

DWC has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule to adopt the following relevant Medicare changes:

CMS’ February 9, 2024 Correction Notice to Final Rulemaking which made updates to the HOPPS Addenda A, B, and P, in addition to updates to the January 2024 Ambulatory Surgical Centers (ASC) Approved HCPCS Code and Payment Rates.

• The CMS Ambulatory Surgical Center Payment System, January 2024 ASC Approved HCPCS Code and Payment Rates-Updated 02/15/2024, Column A entitled “HCPCS Code” of “CY 2024 ASC AA” and Column A entitled “HCPCS Code” of “CY 2024 ASC EE.”
• The Ambulatory Payment Classifications (APCs), CN OPPS Addendum A, B, and C-Updated 02/07/2024.
• The APC Relative Weight CN OPPS Addendum A, B, and C-Updated 02/07/2024.
• HOPPS Addenda A and B (2024 CN OPPS Addendum A, B, and C-Updated 02/07/2024.)
• HOPPS Addenda P (2024 CN OPPS Addendum P.)
• Surgical Procedure HCPCS for services rendered on or after February 15, 2024, HCPCS codes listed in Column A, of CMS’ Ambulatory Surgical Center (ASC) Payment System “CY 2024 ASC AA,” Column A, of CMS’ “CY 2024 ASC EE.”

The CMS update of the HOPPS Addenda A and B may result in modification of values and relative weights of some services. The CMS updates to the HOPPS Addenda A and B and the ASC addenda AA and EE do not effect 9789.34 Table A or section 9789.35 Table B, nor the list of surgical codes used in the workers’ compensation fee schedule. This order identifies and conforms the updated HOPPS Addenda and ASC addenda into the regulations.

Section 9789.35 Table B was modified to remove Coalinga Regional Medical Center because it is a Critical Access Hospital not subject to the HOPPS.

The order adopting the OMFS adjustments is effective for services rendered on or after February 15, 2024, and is posted on the DWC website’s OMFS page.

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