Provider Telehealth Billing Guidance
DCMWC Providers: please see the newly updated "Telehealth Billing Guidance". For additional information regarding the DCMWC telehealth guidelines, please click here.
Attention OWCP Claimants
Effective December 17, 2022, the provider search results have been improved to reflect providers who are actively participating with OWCP Programs. The Program Name (DCMWC, DEEOIC, or DFEC) must be provided when launching the search. Select the “How to Search for a Provider” link above for more details.
DEEOIC Home Health Procedure Code
Effective December 17, 2022, DEEOIC will implement procedure code changes for Home Health services. Visit our News section for more information.
Optum PBM Error Instructions
If you are receiving a login error message on the Optum PBM portal, please click here for further information and resolution.
Ambulatory Surgical Center Services
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.
OWCP DEEOIC Home Health Procedure Code Updates
Effective December 17, 2022, DEEOIC will implement an update to procedure code Authorization and Billing for Home Health (HH) services for reimbursement using hourly and 15-minute incremented procedure codes. In addition, some per-diem Home Health procedure codes will be retired.
Key impacts:
- Providers will not be required to submit new or corrected authorization requests for authorizations submitted prior to 12/17/22 with retired codes
- Authorization requests submitted prior to 12/17/22 with retired per-diem codes will continue to be processed.
- Providers will be able to submit corrections to update units/amount and dates for service lines with retired procedure codes in Approved status after 12/17/22. However, providers will be unable to add new service lines to the same authorization using a retired code.
- If the approved authorization on file contains retired code(s), Providers should use the code(s) when billing. For example, if an authorization is approved on 12/16/22 for 6 months of per-diem home health services, then the provider should continue to use the per-diem codes for billing through the end of the approved date span.
- Providers will receive an RTP reason stating that the “Requested Procedure Code is expired or invalid” if a Home Health authorization request with retired codes is received after 12/17/22.
Please refer to DEEOIC Bulletin No.23-03 for more details.
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 Pricing Updated for RCC to CPT Crosswalk
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