Effective January 1, 2022, in accordance with guidance set forth by the Centers for Medicare and Medicaid Services (CMS), DCMWC introduced two new pulmonary rehabilitation procedure codes, 94625 and 94626, to be billed for pulmonary rehabilitation services.
Effective July 1, 2022, the Healthcare Common Procedure Coding System (HCPCS) pulmonary rehabilitation procedure code G0424, will no longer be covered.
Please note that DCMWC will not pay for at-home pulmonary rehabilitation services.
Preauthorization is not required for in-facility pulmonary rehabilitation services.
Pulmonary rehabilitation providers must be enrolled in the DCMWC provider network to treat miners and receive payment for services. To enroll as a DCMWC provider, please access: the Web Bill Processing Portal<https://owcpmed.dol.gov/portal/> for enrollment instructions.
All bills for pulmonary rehabilitation services must be submitted on the OWCP-1500 claim form. A downloadable OWCP-1500 form<https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1500.pdf> is available. Providers must use current procedure codes 94625 and 94626 when billing for pulmonary rehabilitation services. A bill for pulmonary rehabilitation services must include at least one of the following mandatory components:
1. Physician-prescribed exercise;
2. Education or training;
3. Psychosocial assessment;
4. Outcome's assessment; or
5. An individualized treatment plan.
DCMWC will pay for up to a maximum of 60 one-hour treatment sessions during any 90-day period; or a maximum of 90 one-hour sessions during any 12-month period. Lifetime maximums may also apply.
In accordance with 20 CFR 725.707(b), DCMWC may require reports of treatment from time to time, including an individualized treatment plan for each patient.
There is no change in the procedures for billing for other medical services that may be related to pulmonary rehabilitation services. For example, bills for established patient office visits and pulmonary function tests still do not require a Certificate Medical Necessity (CMN) and can be billed separately as they are now. There is also no change in the procedures for prescriptions for durable medical equipment (DME) or home nursing care, which will require a CMN.
All medical bills should be sent to:
DCMWC/Federal Black Lung Program
P.O. Box 8302
London, KY 40742-8302