Effective July 1, 2026, the Office of Workers’ Compensation Programs (OWCP) will implement utilization review for unlisted dialysis procedures billed under procedure code 90999. This utilization review will apply to three OWCP Programs:
- FECA (DFEC)
- DCMWC
- DEEOIC
Dialysis is a medical treatment that removes waste products and excess fluid from the blood in place of kidney function. Dialysis centers are excluded from OPPS pricing. Dialysis facility services must be billed on the OWCP-04 form or institutional bill using the appropriate Revenue Center Codes (RCC) and corresponding service codes. Professional services must be billed separately on the OWCP-1500 form or professional bill.
Please obtain any required prior authorization for DCMWC and DFEC claimants and submit supporting documentation when billing under the claimant’s OWCP program. For DCMWC: To support billing for CPT 90999 documentation must include: thorough description of the dialysis procedure performed, rationale for using an unlisted code instead of a standard dialysis code, time spent and technical details of the dialysis treatment, the date of service, patient's clinical status and treatment response.
| Procedure | Modifier | Maximum Units | Utilization Limit |
|---|---|---|---|
| Hemodialysis | D8 | One unit per day | Three units per week |
| Peritoneal Dialysis (incl. CAPD/CCPD) | None | One unit per day | Seven units per week |
| Continuous Ambulatory Peritoneal Dialysis (CAPD) | None | One unit per day | Seven units per week |
| Continuous Cycling Peritoneal Dialysis (CCPD) | None | One unit per day | Seven units per week |
Bills exceeding these limits may be reduced or denied. The utilization limits will apply to new bills and adjustments of previously paid bills.
For questions, contact our Call Center at the applicable phone number listed below, where a representative will be happy to assist you.
Division of Coal Mine Workers' Compensation (DCMWC):
1-800-638-7072
Division of Energy Employees Occupational Illness Compensation (DEEOIC):
1-866-272-2682
Division of Federal Employees' Compensation (DFEC):
1-844-493-1966