Official Medical Fee Schedule (OMFS)
Effective: 03/2021
The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work-related injuries and illnesses.
Labor Code section 5307.1 requires the DWC administrative director to adopt an official medical fee schedule for physician services. In California, for purposes of workers’ compensation “physician” is defined by Labor Code section 3209.3 subdivision (a) as follows:
“Physician” includes physicians and surgeons holding an M.D. or D.O. degree, psychologists, acupuncturists, optometrists, dentists, podiatrists, and chiropractic practitioners licensed by California state law and within the scope of their practice as defined by California state law.
Thank you Dr. Kevin Uchida for your input
**OMFS Fee Schedule effective for DOS on or after 03/01/2021 | ||||||
CPT | Description | Work RVU | PE RVU | ME RVU | 1st code | 2nd codes |
99202 | E/M initial | 0.93 | 1.10 | 0.09 | $107.12 | |
99203 | E/M initial | 1.60 | 1.51 | 0.15 | $163.51 | |
99204 | E/M initial | 2.60 | 2.04 | 0.23 | $242.92 | |
99212 | E/M estab | 0.70 | 0.88 | 0.05 | $82.82 | |
99213 | E/M estab | 1.30 | 1.25 | 0.10 | $133.34 | |
99214 | E/M estab | 1.92 | 1.70 | 0.14 | $188.78 | |
Modalities 97012 | Traction | 0.25 | 0.17 | 0.01 | $21.53 | $16.95 |
97026 | Infrared | 0.06 | 0.12 | 0.01 | $9.70 | $6.47 |
97032 | TENS man 15 min | 0.25 | 0.17 | 0.01 | $21.53 | $16.95 |
Procedures 97110 | Therapeutic exercise 15 min | 0.45 | 0.40 | 0.02 | $43.89 | $33.11 |
97112 | Neuromusc re-educ | 0.50 | 0.49 | 0.02 | $51.14 | $37.94 |
97124 | Massage 15 min | 0.35 | 0.49 | 0.01 | $43.58 | $30.38 |
97140 | Man Therapy 15 min | 0.43 | 0.35 | 0.02 | $40.23 | $30.80 |
97530 | HEP 15 min | 0.44 | 0.67 | 0.02 | $57.96 | $39.90 |
97535 | Self-care, ADL 15 min | 0.45 | 0.50 | 0.02 | $49.28 | $35.80 |
97810 | Acup initial 15 min | 0.60 | 0.41 | 0.05 | $52.68 | $41.63 |
97811 | Acup add 15 min | 0.50 | 0.26 | 0.04 | $39.44 | $32.43 |
97813 | Electro-acup initial 15 min | 0.65 | 0.51 | 0.05 | $60.47 | $46.73 |
97814 | Electro-acup add 15 min | 0.55 | 0.40 | 0.05 | $49.73 | $38.96 |