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What Is the Official Medical Fee Schedule?

California employees who are injured on the job are covered by workers’ compensation, which pays for appropriate medical expenses. In an effort to control the workers’ comp budget, the state has an approved schedule of fees for all medically necessary services provided by healthcare professionals, from the ambulance ride to physical therapy. This document is called the Official Medical Fee Schedule (OMFS).

Medically necessary services are defined as treatments or services that are appropriate for a job-related injury or condition and considered to be a standard medical practice. The OMFS covers the following:

  • Ambulance fees
  • Durable medical equipment
  • Inpatient hospital care
  • Outpatient hospital care
  • Lab results
  • Pharmaceuticals
  • Physician services

Any person or company that provides any of these listed services to an injured employee must submit their bill to the claims administrator handling the case. In general, injured employees do not need to be concerned with the bureaucratic complexities of OMFS billing codes. However, recent changes to OMFS consultation codes eliminated compensation for the review of medical records.  This puts injured workers at a significant disadvantage, especially those with complicated cases. If a claim is disputed, the Independent Medical Review can make a decision, even if a review of medical records has not been performed.

Reforms meant to protect the state budget should not jeopardize the rights of California employees to get the medical treatment and care they need following a workplace injury. If you need to file a workers’ comp claim, consult with an expert workers’ compensation attorney about your rights and options under current California law.

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