The California Division of Workers’ Compensation (DWC) has recently finalized changes to the Medical-Legal Fee Schedule  effective April 1, 2021. The changes eliminate consideration of complexity factors and instead establishes flat fees for initial evaluations, follow-up evaluations and supplemental reports.

Other significant changes found in the update—outlined in the California Code of Regulations Sections 9793 through 9795—include:

• A standardized missed appointment reimbursement ($503.75)
• Page-based reimbursement ($3/page) for medical record review in excess of pages included in medical-legal evaluation billing codes
• Increases in reimbursement for medical-legal testimony
• Adoption of new modifiers documenting psychiatric or psychological (96), toxicology (97) or oncology (98) evaluations

Additionally, the updated regulations will require physicians to include in their medical-legal evaluation a verification under penalty of perjury of the total number of pages of records they reviewed as part of the evaluation and preparation of the report.

For more information on the updated regulations, visit the DWC website.