On January 11, 2025, the Office of Workers’ Compensation Programs (OWCP) will implement new utilization review edits to limit billing for services performed on the same date of service.
This utilization review will apply to three OWCP Programs: DCMWC, DEEOIC, and DFEC.
The EOB descriptions for each edit will appear on the remittance voucher (RV) with the following verbiage:
Coverage/program guidelines were exceeded: Exceeds number/frequency approved/allowed within the time period.
New limits have been defined for the following services:
| EOB Number | Applicable Procedure Codes | Utilization Review |
|---|---|---|
| 80432 | 98970, 98971, 98972 | Assessment is allowed once per day, per same servicing provider NPI |
| 80434 | 99441, 99442, 99443 | Telephone evaluation is allowed once per day, per same servicing provider NPI |
| 80435 | 99374, 99375 | Home health agency service is allowed once per day, per same servicing provider NPI |
| 80436 | 99377, 99378 | Hospice service is allowed once per day, per same servicing provider NPI |
| 80437 | 99379, 99380 | Nursing facility is allowed once per day, per same servicing provider NPI |
| 80438 | 98966, 98967, 98968 | Telephone assessment is allowed once per day, per same servicing provider NPI |
| 80439 | 99421, 99422, 99423 | Online digital evaluation is allowed once per day, per same servicing provider NPI |
| 80440 | 99446, 99447, 99448, 99449 | Interprofessional EHR assessment is allowed once per day, per same servicing provider NPI |
| 80441 | 99231, 99232, 99233 | Subsequent hospital inpatient or observation care service is allowed once per day, per same servicing provider NPI |
| 80442 | 99234, 99235, 99236 | Hospital inpatient or observation care service is allowed once per day, per same servicing provider NPI |
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