New 2025 Telehealth Billing Requirements for California Workers’ Compensation

California’s Division of Workers’ Compensation (DWC) has introduced new telehealth billing rules, effective February 1, 2025. These updates align the Official Medical Fee Schedule (OMFS) with Medicare’s latest telehealth guidelines and bring significant changes to reimbursement processes for healthcare providers treating injured workers.

If your practice relies on telehealth for workers’ compensation cases, failing to adapt to these changes could lead to claim denials and lost revenue.

🔹 Key Updates Include:

✅ New billing code modifiers for audio and video consultations

✅ Audio-only telehealth now allowed for all services
✅ Elimination of three key telehealth billing codes
✅  Introduction of non-payable telehealth procedure codes

At Medrina Technology Management, we help providers navigate these new telehealth billing regulations, ensuring full compliance while maximizing reimbursements.

What These Changes Mean for Healthcare Providers

1. New Telehealth Modifiers Required for Billing

To ensure proper reimbursement, providers must now use specific modifiers when billing for telehealth services:

✅ Modifier 93 – For audio-only consultations, providers must add Modifier 93 to their billing codes.

✅ Modifier 95 – For audio-video consultations, Modifier 95 must be used.

💡 Why This Matters: Incorrect or missing modifiers could result in claim rejections or payment delays from workers’ compensation payers.

2. Audio-Only Telehealth is Now Accepted for All Services

Previously, California required video conferencing for most telehealth visits. Now, all telehealth services can be conducted via audio-only interactions, as long as the provider documents the reason why video wasn’t used.

💡 Key Takeaway: Providers can expand telehealth access to injured workers who may not have reliable video capabilities, but proper documentation is critical for reimbursement.

3. Deleted Telehealth Billing Codes

The DWC has removed three key telehealth CPT codes from its workers’ comp reimbursement list:

❌ CPT 99441 – Phone consultation (5-10 min)
❌ CPT 99442 – Phone consultation (11-20 min)
❌ CPT 99443 – Phone consultation (21-30 min)

💡 Impact: Providers can no longer bill for these specific phone consultations and must use alternative evaluation and management (E/M) codes instead.

4. New Non-Payable Telehealth Codes Introduced

The DWC has introduced new procedure codes with Status Indicator ‘I’, meaning they are not payable under the new OMFS rules. Instead, providers must use alternative CPT codes for reimbursement.

💡 What to Do: Make sure your billing system is updated to reflect these non-payable codes and their replacements to avoid unnecessary claim rejections.

How Medrina Technology Management Can Help

At Medrina Technology Management, we specialize in workers’ compensation billing and compliance. With these new telehealth updates, our team ensures:

✅ Accurate coding with the correct modifiers (Modifier 93 & 95)
✅ Proper documentation for all audio-only visits
✅ Real-time claim tracking to prevent denials
✅ Billing system updates to reflect new and deleted codes
✅ Appeals and second review filing for denied telehealth claims

We help healthcare providers avoid revenue loss by staying ahead of regulatory changes.

Stay Compliant and Maximize Reimbursements!

If your practice provides telehealth services for injured workers in California, now is the time to update your billing processes. Don’t wait until claim rejections start piling up!

📞 Contact Medrina Technology Management today! Our team will ensure your billing remains compliant, optimize your revenue cycle, and handle denials efficiently.

💬 Are you ready for these changes? Let’s discuss in the comments! 👇