DWC Adjusts Medical Fee Schedule for Hospitals and ASCs

CA DIR Labor News

Published February 27th, 2026

Detected February 28th, 2026

Summary

The California Division of Workers’ Compensation (DWC) has posted adjustments to the Official Medical Fee Schedule for Hospital Outpatient Departments and Ambulatory Surgical Centers. These changes conform to the CY2026 Medicare payment system updates and are effective for services rendered on or after March 1, 2026.

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What changed

The California Division of Workers’ Compensation (DWC) has issued an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS). This adjustment is mandated by Labor Code section 5307.1 and aligns with the Centers for Medicare & Medicaid Services (CMS) Medicare payment system changes for CY2026, including new status indicator codes, APC payment rates, and updates to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System.

This rule is effective for services rendered on or after March 1, 2026. Healthcare providers billing for hospital outpatient or ambulatory surgical center services in California must ensure their billing practices and reimbursement calculations reflect these updated fee schedule rates to comply with California workers' compensation regulations. Failure to adhere to the updated fee schedule may result in payment disputes or denials.

What to do next

Update billing systems to reflect the CY2026 OMFS adjustments for hospitals and ASCs.
Ensure all services rendered on or after March 1, 2026, are billed according to the new fee schedule.

Source document (simplified)

Press Room

NEWSLINE Release Number: 2026-21 Date: February 27, 2026

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

The Administrative Director of 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 the CY2026 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 Centers for Medicare & Medicaid Services (CMS) Medicare changes:

New status indicator code “S1” for skin substitutes and APC payment rate of $127.14 per square centimeter
The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) January 2026 Addendum A
The CMS Medicare Hospital OPPS January 2026 Addendum B
The CMS Ambulatory Surgical Center Payment System, January 2026 ASC Approved HCPCS Code and Payment Rates-Updated 02/11/2026, Column A entitled “HCPCS Code” of “January 2026 ASC AA” and Column A entitled “HCPCS Code” of “January 2026 ASC EE.” The order adopting the OMFS adjustments is effective for services rendered on or after March 1, 2026 and is posted on the DWC website’s OMFS page.