California Workers Compensation Fee Schedule as of 3/1/15

//California Workers Compensation Fee Schedule as of 3/1/15

California Workers Compensation Fee Schedule as of 3/1/15

Workers Compensation Fee Schedule as of 3/1/15

Worker's Compensation Fee ScheduleAs of March 1, 2015 fees for certain workers compensation services have increased along with Medicare fee changes.  Below is a chart which shows some common codes and the 2014 fees vs. the 3/1/15 fees for California Workers Compensation.  Record review is still a bundled code and still not payable without a 5307.1 contract.  Reports are generally still not payable unless it is a Permanent and Stationary Report or if the report is requested by a QME or by the Administrative Director of the DWC.

 

 

CPT CodeDescription2014 Fee3/1/15 Fee
PSYCH CODES
90791Psychological Eval150.51155.64
90792Psychiatric Eval162.26174.82
90833Psychiatric therapy add on code with E&M74.2778.05
9083445 min psychotherapy96.06100.28
9083760 min psychotherapy143.83150.49
90901Biofeedback47.7747.78
96101Psych Testing90.66/hr94.87/ hr
96118Neuropsych Testing by PhD113.37/hr118.29/hr
96118Neuropsych Testing by tech98.31/hr103.77/hr
EVALUATION AND MANAGEMENT CODES
99205Initial OV High complexity237.67252.73
99204Initial OV191.11201.77
99203Initial Ov125.39133.40
99215Ov for established patient167.15178.59
99214Ov for established patient125.14132.93
99213Ov for established patient84.9989.81
99354Extended Face to Face 1st hour114.35120.98
99355Extended Face to Face each additional hour111.68117.23
REPORTS
WC002PR211.9112.01
WC003PR3157.68158.94 max
WC004PR4181.48182.93

 

Documentation of the level of service is key to getting paid appropriately.  Many carriers are down coding 99205 to 99203 and even 99202 in some cases.


For Initial Office Visits the codes require all 3 components:

99201 – Presenting problems(s):  Minor (Time typically 10 minutes)

  • Problem focused history
  • Problem focused examination
  • Medical decision making that is straightforward

99202 –  Presenting problem(s): Low to moderate severity (Time typically 20 minutes)

  • Expanded problem focused history
  • Expanded problem focused examination
  • Medical decision making is straightforward

99203 – Presenting problem(s): Moderate severity  (Time typically 30 minutes)

  • Detailed history
  • Detailed examination
  • Medical decision making of low complexity

99204  – Presenting problem(s):  Moderate to high severity (Time typically 45 minutes)

  • Comprehensive history
  • Comprehensive examination
  • Medical decision making of moderate complexity

99205 – Presenting problem(s):  Moderate to high severity (Time typically 60 minutes)

  • Comprehensive history
  • Comprehensive examination
  • Medical decision making of high complexity

As we can see from above there are four levels of medical decision making.

  1. Straightforward
  2. Low complexity
  3. Moderate complexity
  4. High complexity

 


Most practitioners and lay people can spot a comprehensive history and examination.  There are a few factors that go into medical decision making. 

 

  1. Number of Diagnoses: minimal, limited, multiple or extensive
  2. Amount and or complexity of Data to be reviewed (record review): minimal, limited, moderate or extensive
  3. Risk of complications and or morbidity or mortality: minimal, low, moderate or high.

 


Two of the three above components must be met to qualify for a given level of complexity.

 

So if you have 3 Diagnoses and you review records for 2 hours one would think you have high complexity.  The problem as I see it is that the terms used such as extensive and moderate or multiple are undefined.

 

 

By |2019-03-31T23:35:53-07:00April 7th, 2015|Medical Billing|0 Comments

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