California Orthopaedic Association

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  • Home
  • About COA
    • Origin & History
    • Mission
    • Bylaws
    • COA Board
    • COA Committee/Task Force Chairs
    • Advertising
    • Staff
    • Contact/Forms
  • Membership
    • Join COA
    • Members
    • COA Member Directory
    • Member Discounts
    • Residents
    • Career Center
    • Expense Form
  • Annual Meeting/QME Course
    • 2021 Annual Meeting/QME Course
    • Print CME Certificates
    • Future Meetings
    • Past Annual Meetings & QME Courses

Workers’ Compensation

California Workers’ Compensation Resources

The COA provides its members with this Workers’ Compensation Resource Center to assist you in navigating California’s Workers’ Compensation system — Treatment and Medical-Legal.

Treatment – Official Medical Fee Schedule – Physician and Nonphysician Services 

Background Information

In 2017, the OMFS has fully transitioned to Medicare’s RBRVS system. The fee schedule now is based on a single conversion factor. Reimbursement is set at, on average, 120% of Medicare’s 2012 Fee Schedule. The Fee Schedule is also annually adjusted based on an average Medicare geographic adjustment and the annual Medicare Economic Index adjustment.

California has also adopted unique California billing codes to bill for reimbursable reports. New in 2017, is the ability to again bill the prolonged service codes for non-face-to-face time for reviewing medical records, etc. You have to spend at least 31 minutes before you can bill for the initial 60 minutes of time. Documentation of the time spent is required.

COA publishes a calculated OMFS so that members do not need to individually do the calculations. Starting in 2019, DWC is using the Medicare Geographic Practice Cost Indexes for each region. The most current OMFS can be found below.

Locality Region         2021 OMFS – Effective March 1, 2021
05/06/07 SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO, SAN MATEO, ALAMEDA/CONTRA COSTA COUNTIES), CA
09 SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA
17 OXNARD-THOUSAND OAKS-VENTURA, CA
18/26 LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE COUNTY), CA
51/53 NAPA, CA/ VALLEJO-FAIRFIELD, CA
52 SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA
54 BAKERSFIELD, CA
55/56/57/58/59/60/
61/68/69/70/75
CHICO, FRESNO, HANFORD-CORCORAN, MADERA, MERCED, MODESTO, REDDING, STOCKTON-LODI, VISALIA-PORTERVILLE, YUBA CITY,  REST OF CALIFORNIA
62 RIVERSIDE-SAN BERNARDINO-ONTARIO, CA
63 SACRAMENTO–ROSEVILLE–ARDEN-ARCADE, CA
64 SALINAS, CA
65 SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA
66 SANTA CRUZ-WATSONVILLE, CA
67 SANTA ROSA, CA
71 EL CENTRO, CA
72 SAN DIEGO-CARLSBAD, CA
73 SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA
74 SANTA MARIA-SANTA BARBARA, CA

For all other fee schedules, go to the DWC website.

Medical-Legal Fee Schedule

The Medical-Legal Fee Schedule was last updated on July 1, 2006. At that time, medical-legal evaluations, supplemental reports, or depositions done on or after July 1, 2006 were increased 25% across-the-board. In addition, there were changes to the ML103 complexity factors and two and new ML codes were created. ML105—Medical-Legal Testimony and ML106—Supplemental Reports. Revised Medical-Legal Fee Schedule.

Sample Medical-Legal Reports

  • Template Report/DWC Checklist
  • Sample 1
  • Sample 2
  • Sample 3

Medical Treatment Utilization Schedule

Treatment rendered for injured workers under California’s Worker’s Compensation must be consistent with the Medical Treatment Utilization Schedule (MTUS) (largely based on the ACOEM Treatment Guidelines). If the procedure is not covered by the MTUS, treatment must be consistent with ODG treatment guidelines or other evidence-based nationally recognized guidelines.

UR Review Checklists

To assist our members in documenting conservative treatment, COA has developed a series of Workers’ Compensation Utilization Review Checklists. The checklists can be found at https://coa.org/education/ur-checklists/

UR Feedback Form

In addition, COA has established UR Feedback Form for members to report Good or Bad UR Experiences – https://coa.org/workers-comp-ur-feedback-form/

Request for Authorization/Drug Formulary

You must submit a Request for Authorization (RFA) to request treatment/pharmaceuticals. The RFA form can be found in the DWC forms.

Drug Formulary

By January, 2018, the DWC is expected to release a drug formulary which will also be tied to the ACOEM treatment guidelines. COA has successfully argued that medications needed for post-surgical patients immediately following surgery should be exempted from the prior authorization requirement. A limited number of medications is expected to be included on the “Preferred Drug” list requiring no authorization.

 California Division of Workers’ Compensation Forms

Work Status Report (Word Document – editable form) (PDF)

AMA Guides to the Evaluation of Permanent Impairment (Webinar)

Assessing Pain

The AMA Guides 6th Edition includes a pain disability questionnaire that will help you score a patient’s pain levels. Even though the AMA has released the 6th Edition of the AMA Guides, you would only use the 6th Edition to evaluate disabilities for federal employees. For all other injured workers, continue to use the 5th Edition of the AMA Guides.

In addition, you can use this patient’s pain drawing to help patients describe to you where they are feeling pain.

Coding/Billing Issues Webinars

  • 2017 General Orthopedic Coding Updates 
  • 2017 Foot and Ankle Coding Updates
  • 2017 Spine Surgery Coding Updates
  • 2017 PT and OT Coding Updates
  • 2017 Pain Management Coding Updates

Practice Management Resources

Workers’ Compensation

COVID-19 Resource Center

Upcoming COA Events

  • Thu
    20
    May
    2021
    Sun
    23
    May
    2021

    Monterey Convention Center


Annual Meeting/QME Course

Monterey Convention Center
Portola Hotel & Spa
May 20-23, 2021

Upcoming COA Events

  • Thu
    20
    May
    2021
    Sun
    23
    May
    2021

    Monterey Convention Center

Get in Touch With Us

California Orthopaedic Association
1246 P Street
Sacramento, CA 95814

Phone: 916-454-9884
Fax: 916-454-9882
Email: admin@coa.org

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