Effective May 1, 2014, the Office of Workers' Compensation Programs (OWCP) will begin calculating the maximum allowable fee for pharmacy billings of prescription drugs using a different formula which differentiates between brand name drugs and generic drugs. The maximum allowable fee for brand name drugs will be 90% of the AWP plus a $4.00 dispensing fee, and the maximum allowable fee for generic drugs will be 75% of the AWP plus a $4.00 dispensing fee. This change will affect prescriptions paid under all of the OWCP Programs; Division of Federal Employees' Compensation Act (DFEC), Division of Energy Employees' Occupational Illness Compensation (DEEOIC), Division of Coal Mine Workers Compensation (DCMWC).
The Office of Workers' Compensation Programs (OWCP) will adopt the use of the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) on a schedule aligned with the Centers for Medicare & Medicaid Services (CMS). For services provided on or after October 1, 2014, OWCP will require all providers to only use the ICD-10 code sets. For services provided prior to October 1, 2014, only ICD-9 codes will be accepted.
We will be following CMS guidance for implementing ICD-10 on October 1, 2014. Please visit the CMS ICD-10 website for additional information, resources and the latest news on the ICD- 10 transition,
Effective March 1, 2014, We will accept paper bills submitted on the revised 1500 claim form (version 2/12) with ICD-9 codes.
ICD-10 codes will be rejected as an invalid code until October 1, 2014.
For information about ICD-10 or 1500 form changes click here.
Attention DEEOIC DME Providers - The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has released new guidelines concerning the authorization of durable medical equipment (DME). For information about these new guidelines, please click here
The Division of Federal Employee’ Compensation Act (DFEC) has released new guidelines implementing service limitations for injection CPT codes 20550, 20551, 20552, 20553, and 20526, which goes into effect August 1, 2013.
CPT codes 20550 and 20551 will reimburse 4 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.
CPT codes 20552 and 20553 will reimburse 10 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.
CPT code 20526 will reimburse 3 injections within a 12 month period.
Effective 08/01/2013, The Office of Workers' Compensation (OWCP) will no longer utilize DOL homegrown procedure codes RP120, RP130 AND RP200 (Pain Management). When rendering Pain Management services, providers are to bill and/or submit for prior authorizations using the appropriate HCPCS/CPT codes applicable for the services. Request for prior authorizations for pain management services should include but not be limited to a complete and detailed treatment plan.
As of 03/30/08 a new feature called Provider Search is being offered to all three programs. This feature will help you generate a custom list of providers by entering criteria that describes what you are looking for. When searching the database the search may include the program name, provider type, specialty, provider name, city, state, and zip code. To get started click the Provider Search link in the Available Features section.
- User Activity Reports
- Portal Inquiries
- Entry of Medical Authorizations
- Entry of Provider Enrollments
- Updated portal usage statistics