2025 California Workers’ Compensation Physician Fee Schedule: What Providers Need to Know

Every year, California’s Division of Workers’ Compensation (DWC) updates its Official Medical Fee Schedule (OMFS), impacting reimbursement rates for physicians and non-physician practitioners treating injured workers. For 2025, these changes will take effect starting February 1st, and they could mean higher payments—but only if your practice bills correctly and stays ahead of the updates.

At Medrina Technology Management, we ensure healthcare providers maximize their reimbursements by adapting to these new OMFS updates, coding changes, and payer adjustments. Here’s what you need to know about California’s 2025 Workers’ Compensation Physician Fee Schedule and how to avoid underpayments and denials.

What’s Changing in the 2025 Fee Schedule?

Like every year, the DWC updates the conversion factor that determines physician reimbursement rates. This means small percentage increases in overall payments, but those adjustments won’t automatically be reflected in payments unless claims administrators process them correctly.

Other key changes include:

• Updated CPT Codes & Fee Adjustments – Some procedures will receive higher payments, while outdated codes are being removed.
• Revised “WC” Codes for California-Specific Services – Some workers’ comp services in California have new reimbursement calculations.
• Changes to Geographic Pricing Adjustments – Payment rates may vary based on where you practice.

Why This Matters: If your billing isn’t updated to reflect these changes, you could be underpaid or denied reimbursements for services that should be covered.

Common Issues with Fee Schedule Updates

1️⃣ Payers Not Updating Their Systems on Time
Even though the DWC mandates these updates, claims administrators don’t always update their systems immediately. That means some providers will still be reimbursed at old, lower rates unless they catch the mistake and appeal it.

2️⃣ Inaccurate Billing Practices
Billing for workers’ comp is already complex, and incorrect CPT or WC codes can lead to denied claims or underpayments. Providers who don’t adjust their billing for new codes and rate changes could leave money on the table.

3️⃣ Delayed Appeals for Underpayments

Many providers accept incorrect reimbursement rates without realizing they can challenge and recover underpayments. The 2025 changes mean it’s more important than ever to review payments carefully and submit appeals when necessary.

How Medrina Helps You Get Paid Correctly

At Medrina Technology Management, we specialize in ensuring healthcare providers don’t lose revenue due to payer errors, outdated billing practices, or improper denials.

✅ We track OMFS updates in real time – Our team stays ahead of fee schedule changes so you never miss an increase in reimbursements.
✅ We ensure accurate coding & compliance – All CPT and WC codes are updated in our billing process to avoid errors.
✅ We fight underpayments & denials – If a claim is processed at the wrong rate, we appeal aggressively to recover lost revenue.
✅ We optimize your entire revenue cycle – From claims submission to appeals and follow-ups, we ensure you get paid what you’re owed.

A Case Study: Recovering Lost Revenue from Improper OMFS Payments

A California orthopedic clinic partnered with Medrina after noticing unexpected payment reductions on their workers’ comp claims. After reviewing their billing records, we found that:

• Over 30% of their claims were underpaid due to outdated reimbursement rates.
• Several CPT codes were not updated to reflect the latest OMFS values.
• The clinic had not appealed these payment discrepancies, leading to tens of thousands of dollars in lost revenue.

How to Protect Your Revenue in 2025

🔹 Update Your Fee Schedule Immediately – Ensure your billing reflects new OMFS rates starting February 1st.
🔹 Monitor Payer Compliance – Don’t assume claims administrators are paying correctly—verify every reimbursement.
🔹 Appeal Underpayments – If you’re paid at outdated rates, challenge it immediately to recover the correct amount.
🔹 Work with Billing Experts – Partnering with specialists like Medrina Technology Management ensures you never miss a reimbursement increase.

Final Thoughts: Maximize Your Workers’ Comp Payments in 2025

With California’s 2025 Workers’ Compensation Physician Fee Schedule taking effect, now is the time to review your billing practices, update your fee schedule, and ensure you get paid what you deserve.

At Medrina Technology Management, we help providers navigate complex workers’ comp billing, track fee updates, and fight underpayments so you can focus on what truly matters—your patients.

💰 Don’t let incorrect billing cost you money!  Medrina Technology Management ensures your practice stays compliant, maximizes reimbursements, and avoids costly underpayments.

📞 Let’s optimize your revenue cycle—contact us today!