What Is California Labor Code §5307.1: Official Medical Fee Schedule?

(a) (1) The administrative director, after public hearings, shall adopt and revise periodically an official medical fee schedule that shall establish reasonable maximum fees paid for medical services other than physician services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods described in Section 4600 and provided pursuant to this section.

What Does California Labor Code 5307.1 Do?

It tells the state to set a price list for medical bills in a California workers' comp claim.

Section 5307.1 does not send money to you directly. It controls how much the claims administrator pays a provider for treating your work injury. The administrative director at the Division of Workers' Compensation, often called the DWC, writes this price list, the OMFS. DWC's OMFS page lists what it covers: ambulance fees, durable medical equipment, inpatient hospital care, outpatient and surgery center care, lab work, pharmacy, and physician services.

The OMFS applies to every provider who bills a California work injury claim, from your treating doctor to a hospital, lab, or pharmacy. It applies whether your employer buys insurance or self-insures. It works alongside Labor Code 4600, the law that gives an injured worker the right to treatment in the first place. Eman Yazdchi is a Certified Specialist in workers' compensation law, certified by the California Board of Legal Specialization, State Bar of California.

How Does the Fee Schedule Work in a Real Workers' Comp Claim?

Your provider bills the claims administrator directly, using the fee schedule as the ceiling.

A claim usually starts with a treating doctor asking the claims administrator to approve care. That step runs through Utilization Review under Labor Code 4610, which asks whether the care is medically needed. Section 5307.1 answers a different question: once care is approved, what can the provider collect for it? The doctor, hospital, lab, or pharmacy submits an itemized bill to the claims administrator. Under Labor Code 4603.2, the claims administrator must pay or send a written explanation of review within 45 days of receiving that itemized bill, and the OMFS rate sets the top amount it can pay.

How Much Does the Schedule Pay, and How Often Does It Change?

Most fees track a fixed share of Medicare, and the rates change on a set schedule.

For physician and non-physician practitioner services, section 5307.1 bases payment on Medicare's resource-based relative value scale, a system that scores each service. Since January 1, 2017, the law has paid 120 percent of the 2012 Medicare conversion factor, adjusted each year under the formula in subdivision (g). For a service with no Medicare match, the administrative director sets a fee that cannot exceed 120 percent of what Medicare pays for comparable work. Drugs and pharmacy services generally cap at 100 percent of the Medi-Cal rate.

The rates keep moving. Subdivision (g) requires the administrative director to update the schedule within 60 days of a related Medicare or Medi-Cal change and to post the order on DWC's website. DWC does this on a regular cycle. On July 7, 2026, for example, DWC posted an order updating the hospital outpatient and ambulatory surgical center rates to match Medicare's payment changes effective July 1, 2026, citing section 5307.1 as its authority. The current rates and past orders are on DWC's OMFS page.

What Exceptions and Limits Does Labor Code 5307.1 Set?

A few carve-outs lower the cap further, and a contract can replace it.

A hospital outpatient department's facility fee caps at 120 percent of Medicare's matching rate. An ambulatory surgical center billing that same procedure caps lower, at 80 percent of Medicare's hospital outpatient fee for it. Medical-legal expenses, the costs tied to a contested claim under Labor Code 4620, generally sit outside the OMFS and follow a separate fee rule, except that Labor Code 4626 still prices the X-ray, laboratory, and other diagnostic test charges inside that evaluation under the OMFS. A compounded drug a physician dispenses directly is billed ingredient by ingredient under a national drug code, and the reimbursement generally caps at no more than $20 above the documented cost. A dangerous device, or another pharmacy good a physician dispenses directly, caps separately, generally at no more than $250 above the documented cost.

Section 5307.1 also lets a payer and a provider agree to different terms. Subdivision (h) allows a contract that sets its own reimbursement rate, which is how a Medical Provider Network under Labor Code 4616 can pay a rate other than the OMFS maximum.

How Does Labor Code 5307.1 Connect to Other California Workers' Comp Rules?

It sets the price only after other rules decide what care happens and who can bill for it.

Labor Code 4600 gives you the right to treatment, and section 5307.1 points back to it throughout. Labor Code 4610 decides whether a specific request gets approved; section 5307.1 only prices it once approved. Labor Code 4603.2 sets the deadlines and paperwork for billing and paying under that OMFS rate. Section 5307.1 even borrows a definition from Labor Code 139.3, the physician self-referral law, for what counts as pharmacy goods.

If you think a bill for your work injury care was paid at the wrong rate, that is usually a dispute between your provider and the claims administrator, not a debt you have to settle yourself. Keep a copy of every bill, the claims administrator's explanation of review, and your doctor's treatment authorization. Ask the provider's billing office whether it has asked for a second bill review under Labor Code 4603.2. Contact Yazdchi Law P.C., or call (661) 273-1780, if a fee schedule dispute is holding up your care or your claim. The firm reviews each matter individually. For related reading, see our pages on Labor Code 4600 and your right to treatment, Utilization Review under Labor Code 4610, medical bill payment and review under Labor Code 4603.2, Medical Provider Networks under Labor Code 4616, and medical-legal expenses in a contested claim under Labor Code 4620.