California Workers’ Compensation Fee Schedule Updated to Align with Medicare Changes
California’s Division of Workers’ Compensation (DWC) has announced adjustments to its Official Medical Fee Schedule (OMFS), specifically impacting Hospital Outpatient Departments and Ambulatory Surgical Centers. The changes, mandated by Labor Code section 5307.1, aim to align state reimbursement rates with evolving Medicare payment systems.
The DWC order, released this week, adopts several updates from the Center for Medicare & Medicaid Services (CMS) related to the October 2025 quarterly update. These include the CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) October 2025 Addendum A and Addendum B, as well as specific sections of the CMS Medicare OPPS October 2025 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V263.R0.
However, a portion of the update is currently pending further information from CMS. According to the DWC, the October quarter ASC Payment Rates – Addenda have not yet been published. Consequently, the Ambulatory Surgical Centers Payment System Addenda and related Surgical Procedure HCPCS regulatory sections will remain consistent with the July Quarter data until CMS releases its updates.
The updated fee schedule will be effective for all services rendered on or after October 1, 2025, and is now available on the DWC website’s OMFS page. This adjustment ensures California’s workers’ compensation system remains synchronized with federal healthcare payment standards.
The changes are part of an ongoing effort by the California Department of Industrial Relations (DIR), established in 1927, to protect the well-being of over 20 million wage earners in the state and ensure employer compliance with labor laws. The DIR operates under the umbrella of the Labor & Workforce Development Agency.
