DWC Adjusts OMFS for Hospital Outpatient Departments and ASCs

CA DIR Labor News

Published April 1st, 2026

Detected April 8th, 2026

Summary

The California Division of Workers' Compensation (DWC) posted an order adjusting the Official Medical Fee Schedule (OMFS) for Hospital Outpatient Departments and Ambulatory Surgical Centers to align with the CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System April 2026 quarterly updates. The adjustments are effective for services rendered on or after April 1, 2026, as required by California Labor Code section 5307.1.

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What changed

The DWC order adopts CMS Medicare Hospital Outpatient Prospective Payment System April 2026 Addendum A and B changes, Ambulatory Surgical Center April 2026 HCPCS code payment rates, and certain sections of the CMS Medicare OPPS Integrated Outpatient Code Editor. These updates replace prior OMFS rates for affected facility services.

Healthcare providers and facilities billing California workers' compensation for outpatient hospital and ASC services must update their billing systems and reimbursement rates to reflect the new OMFS amounts. Insurers and claims administrators should reconcile claims for services rendered on or after April 1, 2026 against the adjusted fee schedule.

What to do next

Update billing systems with new OMFS rates for hospital outpatient department services
Update billing systems with new ASC payment rates per April 2026 CMS updates
Verify compliance with California workers' compensation fee schedule requirements

Source document (simplified)

Press Room

NEWSLINE Release Number: 2026-32 Date: April 7, 2026

DWC posts adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

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:

April 2026 Quarterly Update

The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2026 Addendum A
The CMS Medicare OPPS April 2026 Addendum B
The CMS Ambulatory Surgical Center Payment System, April 2026 ASC Approved HCPCS Code and Payment Rates Column A entitled “HCPCS Code” of “April 2026 ASC AA” and Column A entitled “HCPCS Code” of April 26 ASC EE”
Certain sections of the CMS Medicare OPPS April 2026 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V271.R0 The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2026 and is posted on the DWC website’s OMFS page.