Ambulatory Surgical Centers should bill for facility charges on the OWCP-1500 using the appropriate AMA CPT® code(s) for the primary, secondary, tertiary, etc. procedures and should use the "SG" modifier with each CPT® code.

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

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

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

After reaching the homepage, select the “Resources” link on the upper right hand of the page. A pop-up window will open. Select link for “List of CMS-Approved Organ Transplant Programs”. This will open an excel spreadsheet which contains certification information for all Medicare-certified transplant programs, organized by State. Please refer to the approved lung transplant programs.

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.

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