Workers’ compensation is insurance that provides cash benefits and medical care for
workers who are injured or become ill as a direct result of their job.
The employer pays for this insurance, and shall not require the employee to contribute to the cost of compensation. Weekly cash benefits and medical care are paid by the employer’s
insurance carrier, as directed by the Workers’ Compensation Board. The Workers’
The Compensation Board is a state agency that processes the claims. If Board intervention is
necessary, it will determine whether that insurer will reimburse for cash benefits and/or
medical care, and the amounts payable.
In a workers’ compensation case, no one party is determined to be at fault. The amount
that a claimant receives is not decreased by the claimant's carelessness, nor increased by
an employer’s responsibility. However, a worker loses the right to workers’ compensation if the injury results solely from their intoxication from drugs or alcohol, or from the intent to
injure themselves or someone else.
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DWC Posts Adjustment to Official Medical Fee Schedule (Ambulance Services)
The Division of Workers’ Compensation (DWC) has posted an order adjusting the
Ambulance Services 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.
The update order is effective for services rendered on or after January 1, 2023, and can be
found at the DWC OMFS Ambulance Fee Schedule webpage.
DWC Posts Additional Adjustments to Official Medical Fee Schedule (Hospital Outpatient
Departments/Ambulatory Surgical Centers)
The Administrative Director of the Division of Workers’ Compensation (DWC) issued an
order on October 4, 2022, adjusting the Hospital Outpatient Departments and
Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to
conform to the quarterly changes in the Medicare payment system as required by Labor
Code section 5307.1. Thereafter, DWC issued an order dated October 21, 2022 adopting
the Centers for Medicare and Medicaid Services (CMS’) revised fee schedule documents
dated October 18, 2022. Subsequently, the CMS issued revised fee schedule documents
dated November 14, 2022.
This Order adopts and incorporates by reference CMS’ HOPPS Addendum A-updated
11/14/2022 and Addendum B-updated 11/14/2022, in place of the previous files, for
services rendered on or after October 1, 2022. CMS erroneously left out APC 9017 from
Addendum A and HCPCS code Q5124 from Addendum B from the prior file and added it
back in the 11/14/2022 corrections.
The Administrative Director update order dated October 4, 2022, and the supplemental order dated October 21, 2022, remains in effect for services rendered on or after October 1,
2022, except as modified by the Administrative Director order dated November 21, 2022.
DWC Posts Adjustments to Official Medical Fee Schedule Inpatient Hospital Section to
Conform to Medicare Changes
The Division of Workers’ Compensation (DWC) has posted an adjustment to the inpatient
hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes to the
Medicare payment system as required by Labor Code section 5307.1. The effective date
of the changes is December 1, 2022.
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EPIA inc. is a private Insurance Agency with no ties with legal entities. The information contained in this article is based on information provided by the Medicare Official Website.