OWCP Pricing Updated for RCC to CPT Crosswalk - 10-03-2022

Effective October 1, 2022, Outpatient UB-04 billed lines submitted with both the Revenue Center Code (RCC) and a CPT/HCPCS/OWCP procedure code will be priced based on the procedure code fee schedule. This pricing update will apply to bills submitted for DFEC, DEEOIC, and DCMWC.

Please note that there will be no changes for RCC pricing for lines billed without a procedure code.

In addition, this pricing update will not affect the RCC Codes requiring CPT/HCPCS/OWCP Codes for Outpatient Hospital Services, per the OWCP Fee Schedule.

It also will not affect Outpatient Bills (13x or 14x) that are priced via OPPS for DFEC and DEEOIC Programs, or implant lines billed with RCC 0274 – 0279 that require a manufacturer’s invoice for reimbursement (DFEC program only).

Please click this link to visit the OWCP Fee Schedule page for more information.

For additional information, you may contact our Call Center at the number listed below, where a Call Center 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
OWCP DEEOIC DME and Rehab Authorization Improvement - 09-23-2022

Effective October 1, 2022, DEEOIC will implement process improvements for submitting Durable Medical Equipment (DME) and for Rehabilitative Therapies (Rehab) authorization requests.

Improvements include:

  • Providers will be able to submit corrections to approved Rehab request authorizations.
  • Providers will be able to view the line status of an Authorization Request, including the new status of “Processed - Awaiting Decision” when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

Please note that if any changes are necessary for DME authorization, then the provider can submit a new Authorization Request.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
Important Notice Concerning Coverage of Lung Transplants by the Federal Black Lung Program - 09-14-2022

The Division of Coal Mine Workers' Compensation, or Federal Black Lung Program, requires prior approval of the pre-transplant evaluation for lung transplants and the lung transplant itself for Black Lung beneficiaries (20 C.F.R. § 725.705).

Information about an individual's general eligibility for medical benefits may be obtained by calling the District Office where the patient's claim file is located, or by calling the Black Lung toll-free number at (800) 638-7072. Eligibility for medical benefits does not automatically include approval for a pre-transplant evaluation or a lung transplant.

Before seeking approval for a pre-transplant evaluation or a lung transplant, a medical center must be approved as a lung transplant center by the Center for Medicare and Medicaid Services (CMS), or the request will automatically be denied. The list of approved transplant centers is available at:

https://qcor.cms.gov/default.jsp?referer=http://qcor.cms.gov/main.jsp

Approved lung transplant centers must determine if the patient's medical benefits are the responsibility of a coal mine operator or insurer or the Black Lung Disability Trust Fund. The patient should have this information. For a pre-transplant evaluation or transplant to be considered, it must be necessitated by the coal miner's black lung condition and directly related conditions. If the patient is covered by an insurer or coal mine operator, the company's approval must be obtained prior to a pre-transplant evaluation or transplant. Pre-transplant evaluation and transplant coverage is decided on a case-by-case basis. The Federal Black Lung Program expects coal mine operators or insurers to provide the same coverage that it does. The documentation that coal mine operators or insurers require to determine whether or not they will approve coverage may vary.

If the patient is covered by the Black Lung Disability Trust Fund, the approval process must be initiated by emailing the request to https://owcpmed.dol.gov or by calling the toll-free number (800) 638-7072.

Requests for pre-transplant evaluations and lung transplants should include basic information including the patient's name and date of birth, as well as the name of the facility performing the evaluation or transplant.

Additionally, a request for a pre-transplant evaluation must include a physician's letter of justification. A physician's letter of medical justification is a well-rationalized narrative statement, prepared by a qualified physician who has been actively treating the patient for their pulmonary condition. The letter of medical justification represents the physician's independent assessment and opinion and must include a brief review of the claimant's pertinent medical history, a brief statement regarding the claimant's current medical condition, and explanation of the claimant's medical need for a lung transplant evaluation.

Requests for lung transplants must include the medical facility's lung transplant protocols and all medical records produced for the pre-transplant evaluation, including the results of all tests, consultations, and narrative reports.

After the Federal Black Lung Program evaluates the information submitted, it will notify the requestor of a determination regarding coverage. Any pre-transplant evaluation or transplant performed prior to receiving prior approval by the Federal Black Lung Program will be denied.

Any questions about pre-transplant evaluations or transplants should be directed to the Division of Coal Mine Workers' Compensation at efax-maos-transplant@dol.gov or by calling the toll-free number (800) 347-2502.

DFEC Psychological Exams and Evaluations Utilization Review (UR) - 08-22-2022

Effective August 20, 2022, the DFEC program will be implementing new utilization review (UR) for psychological exam and evaluation procedure codes. This change will impact professional, outpatient, and prompt pay bills.

Please refer to the DFEC Bulletin at this link for more information.

You may also contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

Division of Federal Employees’ Compensation (DFEC): 1-844-493-1966

OWCP Updates to DFEC Surgical Package Authorization and Bill Processing - 07-01-2022

As of July 9, 2022, OWCP will implement enhancements to Surgical Package Authorization and Bill Processing for DFEC. Updates will be made to better reflect the providers involved in providing the surgical procedure.

Enhancements will include:

  • Adding new Professional Type for Co-Surgeon for both online and paper authorization requests
  • Allowing the same surgical package authorization request to cover all Professional Types
  • Enhancing the authorization utilization and bill history screen to include Professional Type

You may also contact our Call Center at the number(s) listed below where a Call Center representative will be happy to assist you.

Division of Federal Employees' Compensation (DFEC) 1-844-493-1966

ANNOUNCEMENT CONCERNING IN-FACILITY PULMONARY REHABILITATION SERVICES FOR BLACK LUNG BENEFICIARIES - 06-02-2022

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

OWCP DEEOIC Home Health Authorization Status Updates - 05-24-2022

Effective May 28, 2022, DEEOIC Home Health Requests for authorizations submitted by the provider will be combined into a single Authorization Request number to align to the authorization decisions made by the DEEOIC Program.

Additional improvements include:

  • Providers will be able to submit corrections to approved Home Health request authorizations.
  • Providers will be able to view the line status of an Authorization Request, including the new status of "Processed - Awaiting Decision" when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
OWCP Updates to Unlisted J-Code Billing for Outpatient UB-04 - 05-19-2022

Effective May 28, 2022, new billing requirements will go into effect for unlisted HCPCS J-codes submitted on Outpatient UB-04 forms for DFEC and DEEOIC programs.

This change affects unlisted J-codes: J3490, J3590, J7999, J8499, J8999 and J9999

New mandatory requirements when billing with for unlisted J codes:

  1. Line must include the appropriate Revenue Center Code (RCC) per the OWCP Fee Schedule. Visit this link for further details.
  2. Line must include a valid National Drug Code (NDC)
    • For paper, include the NDC in box 43 of the UB-04
    • For EDI and web portal Direct Data Entry (DDE), enter the NDC in the applicable field

If any of the required fields are invalid or missing, your bill may be denied.

You may also contact our Call Center at the number(s) listed below, a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
  • Division of Federal Employees' Compensation (DFEC) 1-844-493-1966
Medically Unlikely Edits (MUEs) - 03-08-2022

Effective March 5, 2022, Medically Unlikely Edits (MUEs) will apply to bills submitted for DFEC, DEEOIC, and DCMWC Programs.

Please refer to the OWCP bulletin for additional information by clicking here.

You may also contact our Call Center at the number(s) listed below. A Call Center 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