Effective October 26, 2024, the Office of Workers’ Compensation Programs (OWCP) will implement new utilization review to assign limits for specific services.
This utilization review will apply to three OWCP Programs: FECA (DFEC), DCMWC, DEEOIC.
New limits have been defined for the following services:
| EOB Number | EOB Description | Applicable Procedure Codes | Utilization Review |
|---|---|---|---|
| 80429 | Coverage/program guidelines were exceeded: Exceeds number/frequency approved/allowed within the time period. | 99490, 99491, 99487, 99474, 99454, 99091, 99457 | Procedures are limited to 1 unit per 30 days. |
| 80430 | Lifetime benefit maximum has been reached: This service is paid only once in a patient’s lifetime. | 99473, 99453 | Blood pressure and physiological monitoring device limited to 1 per lifetime. |
| 80431 | Coverage/program guidelines were exceeded: Exceeds number/frequency approved/allowed within the time period. | L0140 | Cervical collar limited to 2 units per 365 days. |
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
Posted Date