OFFICE OF WORKERS' COMPENSATION PROGRAMS

Effective November 1, 2025, the Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation (DFEC) Program implemented a new Utilization Review (UR) for special reports or forms billing.

Billing Utilization Review for special reports or forms allows:

• Up to 12 units per year for services occurring within the first three (3) years from the ill or injured worker’s date of injury.
• Up to 2 units per year for services occurring more than three (3) years from the ill or injured workers’ date of injury.

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

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

Fees for some categories of services will be published separately as standalone fee schedules. Examples include:

• Home Healthcare Fee Schedule (HHC)
• Dental Fee Schedule, Durable Medical Equipment, Prosthetics, Orthotic Devices, Orthotics, and Supplies (DMEPOS)
• Clinical Laboratory Fee Schedule (CLINLAB)
• Physician-Administered Drugs and Biologicals (PADB)

The Table of Relative Value Units (RVU) and Conversion Factors (CF) will no longer display pay status. The "Pay Status" was removed on the 08/29/2025 file. This change was made to maintain consistency across all OWCP fee schedules, which do not display coverage status within the published schedule. Previously, "Pay Status" served as an indicator of coverage status. To provide more accurate and timely information, coverage status should be determined directly through OWCP's Workers’ Compensation Medical Bill Processing (WCMBP) portal. Providers and claimants should use the "Eligibility Inquiry" function within the portal to confirm whether a specific service code is covered. Accessing this information through the WCMBP portal ensures that providers and claimants are viewing the most current details available.

The Table of RVUs and CFs now includes a new column with the header "Maximum Allowable Amount (MAA)." When the MAA is shown, providers can disregard the RVUs, GPCIs, and CFs to determine MAA payment.

The HHC, dental, and CLINLAB fee schedules now only display the MAA applicable to all service localities. Reimbursements will not be adjusted by geographic practice cost indexes (GPCIs).

Reimbursement for hearing aids is inclusive of all associated costs, including but not limited to dispensing, fitting, programming, and delivery. Separate charges for these services are not authorized as they are considered integral to the provision of the hearing aid device.