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DFEC Announcement: Current Procedural Terminology Code (CPT) 99070 Bill Payment Restrictions
Beginning June 1, 2019, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) will no longer recognize CPT code 99070 as a valid reimbursable code. For reimbursement of covered supplies, materials, and medication, an appropriate Level II HCPCS code must be submitted. This policy is described in FECA CIRCULAR 19-07, which can be found on the DFEC website at
https://www.dol.gov/owcp/dfec/medicalprovider.htm. DFEC Announcement: Non-Covered NDCs (FDA Medical Devices)
Beginning February 22, 2019, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy to deny payment of a select group of FDA Medical Devices. The list of items to be denied will be identified by National Drug Code (NDC). Any bill identified as containing a charge for any such non-covered NDC will be denied in its entirety. A listing of non-payable NDCs will be available on DFEC's website at https://www.dol.gov/owcp/dfec/.
DFEC - Billing Unspecified J Codes (J3490, J3590, J7999, J8499, J8999, and J9999)
Beginning June 1, 2018, payment for medications billed under these codes will require prior authorization by DFEC claims staff. A strict exception based policy is described in FECA CIRCULAR 18-06, which can be found on the DFEC website at https://www.dol.gov/owcp/dfec/medicalprovider.htm. Prior authorization may be requested by utilizing the Unspecified J Code Authorization Request, which is available at https://owcpmed.dol.gov . This is the only method available for requesting prior authorization. Bills for these codes received on and after June 1, 2018 without prior authorization will deny.
DFEC Announcement: Non-Covered NDCs (FDA Medical Devices)
Beginning February 22, 2019, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy to deny payment of a select group of FDA Medical Devices. The list of items to be denied will be identified by National Drug Code (NDC). Any bill identified as containing a charge for any such non-covered NDC will be denied in its entirety. A listing of non-payable NDCs will be available on DFEC's website at https://www.dol.gov/owcp/dfec/.
DFEC Opioid Medication Letter of Medical Necessity Requirements
Beginning in August 2017, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will require claims with newly prescribed opioid use (i.e. claims where an opioid has not been prescribed within the past 180 days, if ever) to have a completed and approved Letter of Medical Necessity (LMN) form on file for prescription authorizations after an initial 60 day period. Additionally, compounded medications containing opioids will require a completed and approved LMN prior to dispensing, effective June 26, 2017. This form will be made available to registered providers beginning in June 2017 at https://owcpmed.dol.gov/portal/main.do.
To submit the form, providers must click on the 'Provider' Link to the right of the FECA oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. Authorizations for opioid medications will be limited to a maximum of 60 days, with initial fills and refills to be issued in no more than 30-day supplies. Beneficiaries already receiving opioid prescriptions will not be subject to the LMN requirement at this time. For additional information, please see the DFEC website at https://www.dol.gov/owcp/dfec/ for further information under the "Latest News" section.
DFEC: New Policy on Filling Non-maintenance Medications
Beginning May 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy on filling non-maintenance medications for the treatment of work-related injury or illness. The program's policy will limit the fill of non-maintenance medications to 30 day increments. Additionally, refills cannot be obtained until 75% of the prescription timeline has passed. Maintenance medications (such as those used to treat chronic conditions like high blood pressure and asthma) will not be subject to these limitations. In determining what constitutes a maintenance medication, DFEC will be relying primarily on First Data Bank classifications. Physicians seeking to have the 30 day/75% fill requirement waived for non-maintenance drugs should submit a written request directly to the responsible DFEC district office because there is no method of requesting an exception through the Web Bill Processing Portal. Waiver of the fill requirements for non-maintenance drugs will be authorized on an exception basis only based on approval of the OWCP Chief Medical Officer or his/her designee.
DFEC Announcement - Herbal Supplements
Beginning March, 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy for authorizing herbal supplements prescribed by physicians for treatment of work-related injuries or diseases. The Program's policy will be to not authorize payment for herbal supplements, unless a claimant's treating physician acquires prior authorization by submitting rationalized medical evidence that supports the herbal supplement's safety, effectiveness, and necessity. To implement this policy, OWCP will rely primarily on First DataBank (FDB) classification. Physicians wishing prior authorization for an herbal supplement should submit a written request directly to the responsible District Office as there is no form or other provision for authorization to be requested through the Web Bill Processing Portal. Herbal supplements are authorized only on an exception basis on approval of the OWCP Chief Medical Officer or his/her designee. For more information, please visit the DFEC website:
https://www.dol.gov/owcp/dfec/PolicyOnHerbalSupplements.htm Billing for TENS Unit Supplies
Effective September 25, 2016, TENs Unit Supplies are no longer billable as individual services and must be billed under HCPCS code A4595 (Electrical stimulator supplies, 2 leads, per month). This allowance includes: electrodes (any type), conductive paste or gel, tape or other adhesive, adhesive remover, skin preparation materials, and batteries (9 volt or AA, single use or rechargeable), and a battery charger (if rechargeable batteries are used). If 2 leads are medically necessary, a maximum of only one unit will be allowed per month for Procedure Code A4595. If 4 leads are medically necessary, a maximum of two units will be allowed per month. The following HCPCs codes are no longer covered as separately billable services; A4365, A4450, A4452, A4455 A4456, A4558, A4630, A5120, A5126, and A6250. All TENs unit supplies must be billed using HCPCS Procedure Code A4595.
Updated DFEC Pharmacy Fee Schedule
Generic Medications: For services billed on or after July 1, 2016, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will calculate the maximum allowable fee for generic drugs at 60% of the average wholesale price (AWP) plus a $4.00 dispensing fee.
Compound Medication Initial Fill Duration
Effective July 1, 2016, the initial prescriptions for compound medication should be for a period not to exceed 90 days. Initial prescriptions for periods greater than 90-days may be subject to further review for medical necessity.
Laterality of Diagnosed Condition(s)
Effective October 1, 2015 Physicians must specify the laterality of a claimant's condition as applicable (e.g. right or left upper extremity, right or left kidney, right or left lung, etc initial encounter) in their medical documents and medical bills in order for a bill not to be denied.
Web Announcement Provider Type 75
Effective February 01, 2015 the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will no longer accept CPT code 99070 when the service is billed by a licensed DME provider. If a DME provider submits a bill for DME services utilizing the procedure code 99070, the service will be denied.
Toll Free Number Announcement
Effective January 2, 2015 the customer service number for questions related to provider enrollment, FECA bill payment, and FECA medical authorization status is changing to a new Toll Free Number from (850) 558-1818 to (844) 493-1966. Change to Outpatient Payment Method - (Outpatient Prospective Payment System - OPPS) DFEC:
Effective October 1, 2014, the Office of Workers' Compensation Programs(OWCP), Division of Federal Employees Compensation (DFEC) will implement a new reimbursement methodology which will be based on the Medicare Outpatient Prospective Payment System (OPPS). The new payment method will utilize medicare's Ambulatory Payment Classifications (APC) as well as the OWCP fee schedule.
The new payment method will apply to outpatient care in all acute care hosptials including general hospitals, freestanding rehabilitation hospitals and long-term care hospitals, with the exception of critical access hospitals and maryland hospitals. When submitting an OWCP-04 form for outpatient services, providers will be required to enter their medicare number in box 51. If the medicare number is missing or invalid, the bill will be denied. Provider Outreach Presentation |