Workers’ Comp to Increase E&M Reimbursement
[Posted 12/21/06]

The Division of Workers’ Compensation (DWC) on Friday announced plans to increase reimbursement for evaluation and management (E&M) procedures effective February 15. The proposed changes would increase the reimbursement for E&M codes (99201 - 99215) by 0.4 to 35.8 percent. The increases will bring workers’ comp physician fees into line with Medicare’s 2006 rates for these services and were calculated based on a weighted average of Medicare’s rates for the nine California regions.

Although DWC is planning a more detailed review of its entire physician fee schedule, the department determined that the E&M increases are necessary now so that physicians are more fairly compensated for the additional work created by new reporting requirements and utilization review processes.

"This is a step in the right direction and CMA appreciates the department's work on this issue," says Frank Navarro, a reimbursement specialist in CMA's Center for Economic Services. "CMA will, however, continue to advocate for additional increases so that physicians are appropriately reimbursed for providing care to injured workers in California."

Formal notice of this rulemaking will be published in the California Notice Register on December 29. A public hearing on the proposed regulations has been scheduled for 10 a.m. on January 24.

Contact: Reimbursement Help Line, 888/401-5911.