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Content Last Revised: 2/14/75
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CFR  

Code of Federal Regulations Pertaining to ESA

Title 20  

Employees' Benefits

 

Chapter I  

Office of Workers' Compensation Programs, Department of Labor

 

 

Part 10  

Claims for Compensation Under the Federal Employees' Compensation Act, As Amended

 

 

 

Subpart I  

Information for Medical Providers


20 CFR 10.811 - When and how are fees reduced?

  • Section Number: 10.811
  • Section Name: When and how are fees reduced?

    (a) OWCP shall accept a provider's designation of the code to 
identify a billed procedure or service if the code is consistent with 
medical reports and other evidence. Where no code is supplied, OWCP may 
determine the code based on the narrative description of the procedure 
on the billing form and in associated medical reports. OWCP will pay no 
more than the maximum allowable fee for that procedure.
    (b) If the charge submitted for a service supplied to an injured 
employee exceeds the maximum amount determined to be reasonable 
according to the schedule, OWCP shall pay the amount allowed by the 
schedule for that service and shall notify the provider in writing that 
payment was reduced for that service in accordance with the schedule. 
OWCP shall also notify the provider of the method for requesting 
reconsideration of the balance of the charge.
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