DWC Posts Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

NEWSLINE

The Division of Workers' Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers 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 Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Center for Medicare & Medicaid Services (CMS) Medicare changes:

October 2025 Quarterly Update

• The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) October 2025 Addendum A
• The CMS Medicare OPPS October 2025 Addendum B
• Certain sections of the CMS Medicare OPPS October 2025 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V263.R0

CMS has not yet posted the October quarter ASC Payment Rates - Addenda. As a result, the Ambulatory Surgical Centers Payment System Addenda and the Surgical Procedure HCPCS regulatory sections remain unchanged with the July Quarter data until CMS posts their updates.

The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2025 and is posted on the DWC website's OMFS page.