The 2026 Order Trail

A dated timeline of what DWC actually did this year

Each entry below is a named administrative action. The pattern is the point: the gap between Medicare publishing a quarterly RVU file and California adopting it into the OMFS has collapsed to near real time.

1. EFFECTIVE APR 1, 2026

   Physician and NPP fee schedule adopts Medicare RVU26B

   DWC's administrative order updates the OMFS Physician and Non-Physician Practitioner fee schedule to conform to Medicare's second-quarter RVU26B file, as required by Labor Code section 5307.1. Every professional service priced on or after this date of service, E/M visits included, keys off the new file.

   SOURCE: CA DIR/DWC Newsline 2026-49
2. EFFECTIVE JUL 1, 2026

   Physician and NPP fee schedule adopts Medicare RVU26C

   Three months later, DWC does it again. The third-quarter RVU26C file becomes the OMFS pricing basis for professional services with dates of service on or after July 1, 2026. Any claim priced against the April file for a July date of service is priced against the wrong schedule.

   SOURCE: CA DIR/DWC Newsline 2026-55
3. JULY 2026 CYCLE

   Hospital outpatient and ASC schedules follow the same rhythm

   The quarterly cadence is not limited to professional services. DWC's hospital outpatient departments and ambulatory surgical centers fee schedule update incorporates the July 2026 Medicare changes, so facility-side workers comp pricing moves on the same clock.

   SOURCE: CA DIR/DWC Newsline 2026-65

The Annual-Load Problem

Where a once-a-year fee load goes wrong

Medicare publishes RVU files on a quarterly rhythm, one file per quarter, and Labor Code section 5307.1 keeps the OMFS conformed to Medicare's payment system. When DWC adopts those quarterly files by administrative order, a biller who loaded the schedule in January is correct for exactly one window.

Why E/M Is the Pressure Point

What quarterly RVU swaps do to workers comp E/M rates

E/M codes are the highest-volume professional services in most workers comp treatment streams, and under the OMFS physician schedule they are priced from the RVU values in the Medicare file DWC has adopted for that date of service. When the operative file changes from RVU26B to RVU26C on July 1, 2026, the payable amount for the same E/M code, same provider, same injured worker, can change mid-year without any annual rulemaking event to flag it.

That creates two symmetrical failure modes. Providers and their billing teams underbill when they price July visits from an April file that has since moved. Payers and bill review vendors generate objections and second-review friction when either side of the transaction is on the wrong quarterly file. Both failure modes are silent, because the claim does not know it was priced from the wrong table. Only a date-of-service lookup against the correct quarterly release exposes the gap.

Operator Checklist

What to change in your revenue cycle this quarter

• Rebuild fee schedule logic as date-of-service driven: the pricer must resolve which quarterly RVU file governs each individual service line, not apply one file per calendar year.
• Subscribe to the DIR/DWC Newsline feed and treat each OMFS administrative order, like Newslines 2026-49, 2026-55, and 2026-65, as a mandatory load event with an owner and a deadline.
• Stand up a quarterly load calendar aligned to the CMS release rhythm, with a verification step that samples E/M codes before and after each effective date.
• Audit claims with April through July 2026 dates of service that were priced before your RVU26B and RVU26C loads landed, and correct underpayments through the second review process where warranted.
• Extend the same discipline to facility claims: the hospital outpatient and ASC schedule moved in the July 2026 cycle per Newsline 2026-65, so facility pricers need the same quarterly refresh.
• Version every fee table. When a bill review dispute arises, you need to prove which quarterly file was in force for the date of service, not just which file you happened to have loaded.

Primary Sources

Cited administrative actions